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HANDBOUND
AT THE

LN1\ ERSITY OF
TORONTO PRESS

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The Medical Record.

% ^m\-Mni\]\\] 3(ourn;il of ^IcMcuic (iiiii ^iinuri)'.

EDITED BY

GEORGE F. SHRADY, A.M., M.D.

iJoluSu 7.

MAECII 1, 1872— DECE:y:BEE 16, 1872.

%^^

XEAV YORK:

\vilil,ia:m ^vooD & compaxy,

27 GREAT JOXES STREET.

POOLE^ & MACLAUCHLAX,

PRINTERS AND BOOK. HINDERS,
205-213 East \2ih St.

INDEX TO VOLUME VII.

Abdomen, impalement of, 198.

Abortion, frequency of retained placentn in, .'520.

Acid nitrate of mercury, in induration of womb, 151.

Acne, remarks on, 54(5. 577.

Aconite-poisoning, 3G ; test for root of, 515.

^tbylidenchloride, 275.

After-pains, citric acid in, 108.

Aiken, S. C. , a resort for invali Is, 43.

Air- passages, death as a cause of disease of. 388.

Air, compressed as a remedial agent. 31 ; on poisoned,

55!.
Albuminuria, cathartics in, 30; during fertility, 442.
Albuminuric retinitis, OG.
Alcohol, action of, 346, 407 ; treatment of wounds by,

223.
Alkaloids, comparative value of, 328.
AUbutt, T. C, review of work by, 20.
Althof, Dr. H.. canthoplasty, 34.
Alumni Association of Collejje Physicians and Surgeons,

93 ; University of New York, 95 ; institutions, 399.
American Medical Association, report of, 169, 201, 277,

426.
American Ophthalmol ogical Society, review of transac-
tions of, 19.
American Otological Society, report of, 331.
American Pharmaceutical Association, officers of, 527.
American Public Health Association, 455, 523.
Amherst College, Mass., notice of, 334.
Ammonia, hydrochlorate of, 390.
Amyloid disease, prevented by alkalies, 276.
Anesthesia, discovery of, 187, 336 ; review of work on,

146.
Anesthetic mixture, the, 299.
Anjesthetics, administration of, 396.
Anemia, progressive, 343.
Aneurism, remarks on, 304, 347, 472, 540.
Angioma caverncsum, case of, 120.
Animalcula, poisonous effects of, 397.
Animation, case of suspended. 46.
Animals, a new hospital for, 96.
Aniline colors, adulteration with sugar. 261.
Ankle-joint, compound dislocation of. 251.
Anus, imperforate, 312 ; nourishing by, 368.
Aphonia, 390.

Areolar, vascular tumor of labium, 303.
Army News. 41, 92. 118, 166, 237. 250, 284, 310, 333,

359, 382, 403, 427, 455, 525, 550.
Anny, the medical corps of the, 264.
Arnold, Dr. E. S. F., letter from, 249.
Arnott, Henry, notice of work by, 401.
Arsenic in dyspepsia, 104.
Arterioles, tonicity of, 511.
Artery compressor (illustrated). 213.
Artery constrictor, with cases. 52.
Artesian wells propagating disease, 152.
Ascites, a novel method for tapping, 36.
Aspergillus, case of, 419.
Aspirator, the, 473.

Asthma, a cause of, 442 ; treatment of, 443.
Astigmatism, determination of, 58, 347.
Astragalus, cases of, disease of, o97.
Atlee, Dr. W. L. , review of work by, 543.

Atlo-axial disease. 510.

Aural-catarrh, review of work on, 353 ; polypus, rapid

development of. 418.
Autopsies, neces.sity for, 536.

Bailey, Dr. James S., death after child-birth, 385 ; snake-
bites. 413

Baptisia tiuctoria in typhoid, 465.

Barker, Dr. B. F.. puerperal thrombosis, 521.

Bathing, directions for, 382 ; reduced to a science, 91.

Battey, Dr. R., on cystotomy, 381.

Beard and Rockwell, Drs., on electro-surgery, 292, 434.

Beef essence, frozen, 300.

Beef -tea, worthlessness of, 223 ; new method of making,
296, 323.

Beer, adult-eration of, 551.

Bell. Dr. A. N. , on quarantine, 66.

Bell, Dr. John, of Philadelphia, death of, 432.

Belladonna, antidotal preparations of, 159.

Bellevue Hospital Medical College, 93 ; House Staff,
431.

Bennett, Dr. E. P., dislocation of shoulder, 52.

Bennett, Dr. J. H., review of work by, 203.

Bennett, Dr. W. H. , dust as an exciting cause of disease,
388.

Berberi, case of, 468.

Bile, urea in, 346 ; detection of, 197.

Biliary calculi, large, 360.

Births, male and female in U. S. , 336.

Bladder, cancer of, 276 ; puncture of, 289, 323 ; rup-
ture of, 205, 356, 394, 457 ; impalement of by broom-
stick, etc., 518.

Black list, the physician's, 250.

Blind, the,'^in Massachusetts, 288.

Blindness, from cerebro- spinal meningitis, 341 , photopho-
bia in, 56.

Blood crystals, their physiological importance, 242.

Blood, transfusion of, 58.

Blotting-paper, incrusted, from nostril, 156.

Bodenhamer, Dr. W., traumatic hemorrhage of rectum
(illustrated), 361.

Bones, notice of work on disease.=; of, 279.

Booth, Hamlet of, psychologically considered, 287.

Bougie-a-Boule, a new, 167.

Bradley, Dr. E., letter from, 250.

Brain, effects of removal of, 372 ; colloid degeneration
of, 228 ; in uraemia. 579.

Breath, organic matter in, 335.

Briddon, Dr. Chas. K., elastic artery compressor {illus-
trated), 213 ; surgery of male urethra, 217, 289 ;
tubular aneurism, 472.

Bright's disease, in children, 345 ; eye in, 84 ; work on,
23.

Brigham Hall, report of, 428.

Bromide of potassium, 328 ; notice of work on, 516.

Bronchitis, muriate of ammonia and carbolic inhalation
in, 274, 297.

Bronsou, Dr. E. B. , syphilis corpuscle, 138.

Brown-Sequard on epilepsy, 472, 517. ^

Buck, Dr. A. H. , on Ear Practice, 570.

Buck, Dr. Gurdon, tracheotomy, 12; infra-auricular
tumor, 517.

i^S2

Index to I'ol. V'JI.

Bulklty. Dr. H. D.. notice of denth of. 4.S.

IJulkh-y, Dr. L. D.. cliniciil thernioiiu-tn-. UO.

Bull. Dr. C. S. , atrophy of optic nerve, :!i:{.

Biinistoud. Dr. F. J.. Lo8torfer'« corpuHcles, 1(14. 210.

Bullet, rcniovul of ftoni cranium. t2(M).

Bullets, l»(»(l practite of prubiug for in cavities, o25.

Bunker. Dr. E. S , clay (ircMings in variola, 40.

Burns, treatment of. 2'J(i.

Burrall, Dr. F. A., oxton.sion of wrist (illimlnidd), 143;

ua.s.al doucbe, (Jo ; carbolic acid internally, 52.').
Butler, Dr. S?. W., review of work by, 22.
Byrne. Dr. J., on electric cautery in uterine surgery

(illuiftrateci), 529, 55;i.

Coesarean Foction. ;U2. lis.

Calabar bean and chloral. 101 ; in constipation. 413.

Calculi, 27; in the bladder, 230 ; chlorofonu in treatment
of. 104.

Camphor, monobromate in delirium tremens, 372 ; and
bromine, lOo.

Cancer, rcniarks on different characters, and treatment of,
\',(K 22->. 2:)7, 21)1. :^7!J. 40. 512, 594.

Cancruni oris, treatment of. 414.

Cantharidatc of pota.<h. 540.

Cantharides. poisoning by, 807.

Canthoplasty in conjunctival and corneal aflFections, 34 ;

Carbol. 302.

Carbolic acid, antidote for, 84 ; as an anesthetic, 231 ;
internally, 525.

Caro. Dr. S. A., novel method of tapping, 30.

Carrol's, Dr. A. L., knot-tier (ilhi.stratfed), 3U4.

Castle, Dr. F. A., on nocturnal enuresis, 453.

Castor-oil made palatable, 311.

Cataract, extraction of, 145, 346.

Centipede, sting of. 413.

Cephaljematoraa, 371.

Cerebral abscess. 297. i

Cerebral paralysis, growth of nail as a means of prog-
no.sis of. 108.

Cerebro -spinal meningitis, remarks on characters and
treatment. 34, 51, 71, 102, 206, 345, 265, 268, 384,
297. 2!i9, 341, 466.

Chapman, Dr. E. N., review of work by, 446.

Ch;.rity Hospital Report. 343.

Chemistry and materia medica, report of Section of Ame-
rican Medical Association of, 189.

Chicago, eflfects of fire in, 168.

Chinese surgery, 47.

Childbirth, death after. 385. 439.

Chloral hydrate, remarks on as a remedial agent in dif-
ferent diseases, 104, 105, 106, 197, 324, 329, 415, 416,
420.

Chloride, in place of bromide, of potassium, 31.

Cholera, remarks on, 9, 297, 323, 360.

Cholera infantum. 394. 443.

Chloroform, discovery of, 335 ; uses of, 104, 252.

Chronic cjstiiis. 381.

Cinchona, action of. 303 ; tree, cultivation of, 188.

Cilia, method of destroying, 324.

Circocele.' operation of, 303.

Clarke, Dr. H. K.. on cys otomy, 220.

Clavicle, apparatus for fracture of, 258.

Clay dressings in variola, 40.

Cloves, oil of, as a preservative, 335.

Coal oil in congestion. 372.

Cobbold. Dr. S. . notice of work bj', 471.

Cocoanut-milk. 275.

Cod -liver oil, comparative value of. 329.

Cohen. Dr. J. Soils, notice of work by. 400.

Copaiba, new mode of administering. 324.

College of Physicians and Surgeons, commencement of,
93.

Collodion, cheap. 391.

Communists as lunatics. 408. 471.

Condylomata ; non-syphilitic, removal of, 151 ; endo-
follicular, 511.'

Conjugal onanism. 43.

Conjunciiviiis. treatment of, 304. 509.

ConHonant HoundH. caHos illuBirating. 40.

Constipation, in uterine disease, treatment of. 108, 442.

Convulnions. acute ura-mic, use of opium in, 160; forci-
ble diliverv' for. H2.

Corals, notice of work on. 378.

Coreal ulcer and dental abscess, 418.

Coq)ulence. causf s of. 16K.

Correspondence. 39. 70, 91, 117. 149, 164, 311. 234, 247,
2K4, 308, 332, 358. 379, 403. 426, 477, 525, 549.

Corrosive sublimate, hypodennic injection of, 59.

Consumption, review of work on. 203.

Cow's milk, reaction of. 443.

Creosote, tests for j)urity of. 415.

Croton water siipi»ly, the. 326, 429.

Croup, management of. 228.

Cruse. Dr. Thomas K . fracture of leg, 140.

Curid mango, value of, 329.

Cylindrical glasses, the first pair, 359.

Cystitis in female, treatment of, 84, 107.

Cystotomy, remarks, 220, 381, 549.

Dalton, Dr. E. B., death of, 385.

Dalton, Dr John C, review of work by. 86.

Dana. Dr. James D. , notice of work V>y. 378.

Dawson. Dr. B. F.. a new vaccinator {illustrated), 117.

Dead bodifs. liquefying, 228.

Deaf and Dumb, the uneducated, 336.

Deafness, cured by electricity, 57 ; caused by cerebro-
spinal meningiti.s. 341.

Death, ap{)arent. remarkable case of. 335 ; test of, 574.

Delaware State Medical Society, notice of, 312.

Delirium tremens, chloral in, 197.

Delivery, m.-xnual. in con\'ul8ion8, 82.

De Marmou. Dr. P.. case of. 187, 349, 309.

Denionomania and witchcraft, 96.

Dental inegularity, treatment of, 153.

Dentigerous cysts, 58.

Dentists in the U. S. . 95.

Department of safety, the proposed, 61.

Derby. Dr. A. H , tenotomy in myopia, 64

Diabetes in India, 28 ; treatment of, 367.

Diabetic nvine. new matter in. 251.

Diarrhoea, infantile, treatment of, 228.

Dickson. Prof. S. H.. death of, 163.

Digitalis, an anaphrodisiac, 33.

Diphtheria, recovery after tracheotomy for, 12 ; treat-
ment of. 297.

Diploma traffic, the. 117. 247, 514.

Disinfectants, the best. 329.

Dispensaries, first to suggest the idea of, 335.

Dissecting wounds, treatment of, 197.

Doctor's local quarrels, 301.

Donnelly, Dr. M.. skin grafting, 573.

Dowell. Dr. Greenville, new speculum (illuitrated), 402.

Drowning, prevention of death from, 546.

Drug-bill, remarks on. 17.

Drunkenness, ])roposed law against, in France, 288.

Dry earth a*; a surgical dressing. 420.

Dubois, Dr. H. A., climate of San Rafael, 135.

DufiBeld. Dr. Edward, baptisia tinctoria, 465.

Dugorg oil, 382.

Duncan, Dr. J. M., notice of work by, 304.

Dunning, Dr. W. B. , death from ether, 411.

Dust, as an exciting cause of disease in air-piissages,
388.

Dwyer. Dr. John, cerebro -.spinal meningitis, 51.

Dyspepsia, treatment of, 60, 104, 346.

Dysentery, chlorate of potash in, 351.

E.
Ear, removal of bodies from, 395 ; review of work on, 19 ;
the labyrinth of, 232 ; catarrh of, 444 ; unusual cases
of disease of, 570.
Earth in surgery, review of work on, 205.
1 Eczema, hesitation in curing, 43.

Index to Vol. VII.

583

Editorial articles, 17, fil, >S5, 10!), 15:3, 15r), 201, 229, 277,
:301, 82r), :349, P>78, 308, 421, 44"), 409, 518, 541, 575.

Edson, Dr. B., on c.incer doctors, 879.

Education, .sanitary aspects of, 898.

Elbow, movement plan in fracture of, 418.

Elbow -joint, excision of, 42.

Electric cauter3' in uterine surgery, 529, 553.

Electricity, review of works on, 110, 515.

Electro-surgery, researches in, 202, 484.

Electro-therapeutics, 189, 281, 540.

Electrolysis in stricture of rectum, 209.

Emnienagogue.s, 29(>.

Empyema, latency of symptoms in, 86 ; cases of, 357.

Eueuresis, nocturnal. 848, 458.

Epidemic diseases, report of section of American Medi-
cal Association on. 263.

Epilepsy, character and treatment of, 198, 226, 276, 337,
472.

Epulis, microscopic character of. 59.

Erectile tumors, electrolysis in, 293.

Erysipelas and surface thermometry, 1 94 ; abortive treat-
ment of. 200. 442.

Ether as a beverage, 168; death from, 408, 411 ; effects
of iu labor, 416 ; the first insensibility from, 252 ;
glue, 328.

Eucalyptus, 298.

Evolution, theories of, 396.

Excisions, antiquity of, 549, 577.

External iliac, ligation of, 105.

Extra-uterine [regnancy, 467.

Extraction operations. 848.

Eye, syphilitic inflammation of, 58 ; relation of diseases
of to other diseases, 337.

Fabrics, to render non-inflammable, 222.

Favus, treatment of, 56.

Fecundation, artificial, 222.

Fecundity, extraordinary, 264 ; a work on, 204.

Fees in California, 287.

Female, calculus in, 417.

Female Dentists, 358.

Female patients, our relations to our. 469.

Female physician of the olden time, 403.

Femur, cases of fracture of, 104, 198, 254 ; lengthening
of in sj-philis, 368.

Fermentation, remarks on, 511.

Fever, mixture for. 59 ; lacto-phosphate of lime in, 226 ;
and sewers, 227.

Fibula, fracture of, treatment of, 41 8.

Finnell, death from heart disease, 112 ; on whiskey drink-
ing, 451 ; on aboi-tion, 520.

Flint, Dr. A., aneurism and its relation to syphilis, 37.

FUnt. Dr. A., Jr., notice of work by, 423.

Fostal hypertrophy. :>47 ; remains, attachment of, 228.

Forced Delivery, 107.

Fork, swallowing of a. 46.

Fortun, Dr. C. A., trismus nascentium, 343.

Foundlings and foimdling institutions, 481. 513.

Franciscan Hospital, quarterly report of, 286.

Fra^er. Dr. William, death of, 'diS.

Frisbie, Dr. C. W., on pessema, 308.

Gall-stone, a large, 286.

Galvanic current, therapeutic action of, 328.

Galvanism, strictures, treatment by, 270.

Galvano-caustic, amputation by, 516.

Galvano- Puncture Needle (illustrated), 162,461.

Gangrene of mouth, 462.

Gant, Dr. F. J. , notice of work by, 302 ; Dr. James,

notice of work by, 24.
Gastric Tubuli. 372.
Gastro-hysterotomy, 227.
Gelsemium in irritable bladder, 57.
German surgeons, annual congress of, 234.
Gibbons, Dr. H. , letter from, 880.
Gleet, an astringent for, 105.

Glue bandage in fractures, 275.

Goitre, treatment of, 847.

•Gonorrhoea, remarks on character and treatment of, 199,
225, 299. 468.

Good-Bll, Dr. William, membranous cast of vagina, 40.

Gossypirtm as an anodyne. 108.

Gouley, Dr. J. W. S., on rupture of bladder, 457; ure-
thral fever, 409; retention of urine, curious case of,
483.

Graduation of improper persons, 70, 153, 168, 258.

Green, Dr. T. Henry, notice of work by, 88.

Gross, Dr. S. D., notice of work by, 352.

Grotto near Pistoie, curative properties of, 46.

Habershon, Dr. S. 0., notice of work by, 424.

Hachenberg, Dr. G. P., on tannin packing, 842.

Hairs, changes in direction of, 574.

Hare-lip, cases of, 540.

Hemato-crystalline with irrespirable gases, 242.

Hematoma, complicating internal urethrotomy, 291.

Hematoxylin, 894.

Hamilton. Dr. F. H., notice of work by, 423.

Harle.y, Dr. G. . notice of work by, 802.

Hay-fever, notice of work on, -878.

Hayes, Dr. R. T., letter from Japan, 250.

Health Board and Xuisances, 350.

Health Council, a national, 180.

Health Department and Committee of Safety, 61.

Health Officer of the Port, 18.

Heart, voluntary arrest of action of, 261, 268; anomalous
malformation of. 111 ; .suppcsed cause of disease of,
58, 804 ; death from diseases of, 112 ; needle in the,
288, 416 ; nitrite of amyl in neuralgia of, 392 ; re-
marks on disease of, 419 ; diseases of in pregnancy,
439 ; strain of, 444 ; vegetations in auricle of, 521 ;
statistics of disease of, 420 ; calcareous infiltration of,
442.

Hectic Fever, 296.

Hematuria, malarial,- 418.

Hemicrania. quinine and digitalis in, 105.

Hemoptysis, remarks on, 60, 207.

Hemorrhages, secondary, 120 ; post-partum, 443.

Hemorrhoids, a new forceps for (illustrated), 26; treat-
ment by galvani.sm, 881.

Hemp-saw in excision of polypi, 149.

Hemiplegia in syphilis, 297.

Hermaphroditism, case of, 346.

Hernia, novel methods of treatment for. 57, 105, 346, 414.

Herpes zoster, collodion in, 371.

Hewit, Dr. H. S., on Symes' amputation, 156.

Hewson, Dr. A., review of work by, 205.

Hiccough, management of. 276.

Hip Disease, operation for, 2^9, 410.

Homeopathy and Allopathy, 309, 383.

Honolulu, climate of, 427.

Horse, large intestinal calculus in, 335 ; influenza. 478.

Hospital Appointments. 109, 211, 376.

Hospital Report of a novel sort, 18.

Hunter. Dr. W. C, on pepsin, 477.

Hudson. Dr. E. D., on paraplegia (illustrated), 339.

Humerus, luxatioa froin muscular contraction, 467.

Hutchison, Dr. J. C, on syphilization, 305.

Hutton. Dr. Allen C. on homeopathy, 309.

Hydatid cysts passed per rec;um. 420.

Hydrocele, new treatment of. 104.

Hydrochlorate of aniorphia. 106.

Hydromatous cysts, 897.

Hydrophobia, remarks on. 200, 348, 419.

Hydro-pneumothorax. 512.

Hymen, persistence of after marriage. 335.

Hysteria, fatal case of, 415 ; ischuria of, 57.

niac artery, ligation of, 41 7.

Illinois State Medical Society, notice of, 288.

Impetigo and vaccinia. 371.

Incontinence of urine in children, 417.

584

Index to Vol. VII.

Increase in population. reinarkB on, 17.

Indiana Stato Medical .Society, notica of, 884.

Indipostion n-id its imn t^roraent, 348.

Inebriety, horedit^rj-. 2;{J).

Indican, origin of in nr.no. :M5.

Infants, rare mode of djath in, 231 ; food for, :!91 ; work

on. ;{77.
Infantile paralysis, electricity in. 834.
Infirmaries, first establish mont of, 48.
Influenza among' horses, 47!).
Infra-auricular tumor. .")17.
In.!,'alls. Dr. E. F.. on cy.stotomy, 550.
Insane, ophth.almoloffical examination of the, 152.
Insanity, remarks on, 151, 275. 27G, 372.
Intemperance, comic law of, 480.
Interdental si)lint. :{72.
Intermaniui^'c. remarLs on. 359.
Intermittent fever, carbolic acid in, 224.
Intestinal obstruction, 20S,
Intus.susception. case of, 520.
Iodine, tinct. of, bleached, 510.
Iritis, atropine in syphilitic, 300.
Iron, incompatibles. 00.
Irreducible hernia, a case of, 151.
Ischemia, case of. 339.
Ischium, excision of, 198.

J.
Jackson. Prof. Samuel, death of , 118.
Jacobi, Dr. A., letter from, 213 ; specimens by, 206 ; on

foundling institutions, 481.
Janeway. Dr. E. G. . pathological specimens by, 37, 205,

304, 305. 35() ; on post-mortems, 536.
Jaw. the man with the " iron." 47 ; treatment of fracture

of. 391. 4G0 ; excision of, 540, 579.
Jeffries, Dr. B. Joy, notice of work by, 146 ;
Jervina. experiments with, 130.
Jewish mortality, 335.

Kerosene oil in chronic rheumatism. 414.

Kidney, effects of various liquors on, 30 ; notice of work

on diseases of. 23 ; pathology of contracted, 395 ;

remarivs on fatty, 60.
Knapp. Dr. H. , on cerebro-spinal meningitis, 341 ; on the

ear. 232.
Knee-joint, amputation of. 32, 57 ; resection of, 235,

256 ; cartilage from. 300.
Koumiss, preparation of, 408.

Labor, cases in a private practice of thirty-nine years,
390 ; death after, 385. 439 ; electricity in, 347 ; force
and version in, 151 ; manual force to uterus in,
108; not a painful process, 467; premature artifi-
cial. 418.

Laborde. Dr. J. V., notice of work by, 471.

Lachrv'mal sac. catarrh of the, 510.

Lactic acid as a remedial agent. 329.

Laryngeal growths, causes of, 224.

Laryngeal mirror-holder (illustrated), 358.

Laryngoscopy. 199.

Larvnv. svphilitic ulcerations of, 32; papilloma of,
"411.

Lead -poisoning from snuff, 56.

Lee. Dr. B., notice of work by, 400.

Lee. Dr. C. A. , notice of death of. 4.

Leg. treatment of fractures of, 140.

Leucin and tyrosin, 60.

Leucocythjemia in a pig, 296.

Leucocyte, the. 191.

Leucaemia, a case of, 280.

Leucorrhoe i. treatment of. 392.

Lewis, Dr. Z., Edwards' folding saw, eta (illustrated),
161.

Libraries of New York, 287.

Lidell. Dr. J. A., carbolic inhalations in chronic bron-
chitis. 27^.

Light, blue, as a stimulant. 343.

Lijfhtning, los.s of life by. 2S8. 428.

Lime, phosphate as a remedy, 220 ; locto-phosphate of,

413.
Lipoma, removal of an extensive, 251.
Lips, chronic h^'purtrophy of, 59.
Litbiasin. 395.
Lithotomy and lithotrity, 150. 41fS, 430, 442 ; first case

of in New York, 2f[4.
Little. Dr. J L.. tumor of jaw. 520.
Loring. Dr. E. G , operation for Ht.abismus. 97,
Lostorfer's corpu.scles. 27, 138, 155, 104, 210.
Lung, absence of. 108.
Lupus of the extremities. 234.
Lymphatic uiJema, 370.
Liver, narrow escape of in paracentesis ; furrowed, a case

of. 2S1, 357.
Loomis, Dr. A. L. , on empyema, 357.

M.
Macdonald. Dr. A. E., small-pox statistics, 310, 305,

142.
Iklacula lutea, di.stancG of from optic disc. 32.
Magnetic and mineral springs of ALchigan, notice of

work on, 425.
Magnetic wells, 189.

Maine Medical Association, notice of, 334.
Malarial fever, hemorrhagic, 197, 396.
Mammary tumor, 112.

Manhattan Eye and Ear Hospital reports, 144
Mann, Dr. Ed. C. on skin di.seases, 412.
Markoe, Dr. T. M., review of book by, 279.
Marriage rp/s^.s celibacy, 41.
Massachusetts Gen. Hospital. 384.
Mason. Dr. E.. fajcal accumulations, 114.
Ma.sturbation. a case of. 453.
Mathewson. Dr. A., on criticism. 212.
Meat, new method of preserving, 46 ; extract of, 415.
Medical College commencements, 72, 85.
Medical Library and Journal Association, reports of.

65.
Medical diploma trade. 167. 380.
Medical education, 176, 186 ; fees, 43 ; services, forced,

18. 171.
Medical Register, notice of, 353; and the profession, 421,

445, 453, 525.
Medical experts, 189.
Medical literature, report on, 177.
Medical and Surgical History of the War, 230.
Medical schools, efficiency of, 541.
Medical Society of West Virginia, notice of, 312.
Medical Societv of County of New York, reports of, 33,

90, 231. 448. 523.
Medical staff of U. S. Xavy, 432.
Medical World, final notice of. 64.
Medicine, history of, notice of. 471.
Membrana tympani. anatomy of. 54 ; wounds of. 56.
Menstniation, temperature during, 151 ; phenomena of,

512
Mephitis occidentalis, 466.
Morcurv, injection in syphilis, 511.
Methyline, bichloride of. 45, 369.
Miller, Dr. M. N., on mydriasis, 387.
Military Academy, West Point. 326.
Milk, artificial. 45.

Mind, influence of in therapeutics. 43.
Miner, Dr. Julius F.. on ovariotomy. 13.
Minnesota State Medical Society, officers of. 420.
Microscopic sections of eyes, 58.
Missouri Medical .\ssociation, notice of, 334.
Mitchell, Dr. C. L. , heart disease in pregnancy, 439.
Modem giants, 429.
Morbus coxarius. case of, 303.

Morphia, poisoning by. 47. 372. 391 ; hypodermic injec-
tions of, 225 ; and chloroform. 252.
Moore, Prof. E. 31., on vowel and consonant sounds,

49.
Morris, Dr. Moreau, cerebro-spinal meningitis, 245.

Index to Vol. VII.

585

Mortality of New York, extraordiuaiy, 332.

Mother's Rcigister, notice of, 377.

MoiTse's Ear, sensation in, 419.

Munde, Dr. Paul, foreign letter from, 23G.

Mud-baths, efficacy of, 3!)7.

Murray, Dr. A, galvano-puncture needle (i'lustrrffcd)^

102, 4')1 ; intrauterine pessary (UUistrate.i), 319.
Mushroams, edibie and poisonous, 369.
Mydriasis, case of, 387.
Myopia, tenotomy in, 64.

Naeviis, cured by vaccination, 261 ; an extensive, 150;
cured by electrolysis, 2!)4.

Nails, growth of, as a means of prognosis, 108.

Narceine, hydrochlorate, in hypodermic injections, 200.

Nares, new method of plugging, 84.

Narium, sejitum, abscess of, 28.

Nasal douches, 64.

Naso-pharyngeal tumors, 395, 578.

National Medical Library, 202.

Neck, cystic tumor of the, 418.

Negro mortality at the South, 429.

Needle Forceps, a new (iZ/nstrateii), 26,

Nerves, regeneration of, 511.

Newman, Dr. R. , electrolysis, 209 ; treatment of stric -
ture. 270.

News and Items, 48, 72, 93, 118, 166, 237, 264, 311, 333,
359, 382, 408, 427, 478.

New instruments, 117, 162, 213, 358, 402.

New York Dispensaries, -statistics of, 431.

New York Academy of Medicine, reports of, 6t), 115, 281
305, 328, 474, 521, 546, 577.

New York Hospital, the late, 229.

New York Medico-Legal Society, officers of, 479.

New York Pathological Society, reports of, 36, 111,
15IJ, 295, 280, 30:5, 354, 451, 472, 517, 577.

Nomenclature of diseases, report on, 179.

Noyes, Dr. H. D. , relation of eye diseases with other dis-
eases, 337.

Obituary notices, 41, 162.

Ob.stetric, report of section of American Medical Associa-
tion, 189 ; report of practice, 390.

Opium, use of the acute urasmia, 160 ; poisonous bella-
donna in, 396 ; cultivation of in Tennessee, 526.

Optic nerve, atrophy of, 313, 338 ; strychnia a stimvUus
to, 32.

Ophthalmia, purulent in new-born, 300.

Ophthalmic arterj^ embolism of, 338.

Ophthalmological congress, 383.

Ophthalmology, notice of journal of, 327.

Ophthalmoscope, review of work in uses of, 20.

Ovariotomy, remarks on, 13, 189, 417, 430, 441, 512, M'i.

Orbit, aneurism of, 419.

Organic dynamics, 348.

Os innominata, dislocation of, 105.

Osteo-myelitis, cases of, 156.

Otis, Dr. F. N., .sympathetic suppression of urine, 158.

Otitis interna, division of, 151 ; media, 519.

Otology, lectures on, 56.

Our female brethren. 384.

Ovary, cancer of, 394.

Ovarian cyst, in a child aged eight years. 297; removal
of during acute peritonitis, 512.

Ovarian veins, thrombosis of, 305.

Ozokerit in skin disease, 152.

Oxygen in suffocation from coal gas, 419.

Packard, Dr. C. W. , cerebo-spinal meningitis, 102.

Pain, remarks on, 372.

Painless parturition, 467.

Painting, pathology of, 149.

Pancreatic calculi, 356.

Papilloma of larynx, 41 1.

Palate, the, in health and disease, 359.

Palpation in obstetrics, 416, 419.

Paper dressing, 260.

Paracentesis thoracis, 346.

Paraffine, effects of on skin, 57.

Paraplegia, mechanical treatment of {illustrated), 839.

Parasites, review of work on, 146.

Parisian hospitals. 383.

Pathology, review of work on, 88.

Pathological specimens, the keeping of, 526.

Peasloe, Dr. E R., review of work by, 543.

Peliosis rheumatica, 106.

Pflvis, normal distortion of, 468.

Peiisin, remarks on, 200. 329, 368, 477.

Periuterine celluliiis, 393, 397.

Perineum, supporting the. 391. 393.

Peripheral placentitis, case of, 37.

Peritonitis, acute in child, 281.

Pessary, retained seventeen years, 45, 311 ; int ra-uterine

galvanic, 319.
Pessema, remarks on, 308, 403.
Peters, Dr. J. C. , on quarantine, 68 ; perforation of

pulmonary artery, 580.
Peugnet, Dr. E., hypodermic injection of veratrum album,

114 ; on veratrum viride, 121.
Pharmacy, Board of, 285.
Pharmacy Bill, remarks on the, 17, 64.
Pharyngitis, 393.

Philadelphia, reminiscences of, 170.
Phosphoric acid lemonade, 331.
Phosphorus poisoning, turpentine in, 58 ; experiments

with, 235.
Phthisis, aneurism as a cause of, 305.
Physic, Watson's practice, notice of, 351.
Physicians, duration of life of, 162.
Physiological section of American Medical Association,

report of, 191.
Physiology, review of work on, 86, 362, 423.
Piles, suppository for, 296 ; new forceps for, 26.
Pills, a new excipient for, 216.
Plaster Paris splints, 140, 150.
Plastic apparatus in surgery, 389.
Pleurisy, early blistering in, 297.
Pleuritic effusion treated by thirst, 30.
Pneumonia, early blistering in, 297 ; aconite in, 390.
Poisoning, by hydrochloric acid, 84 ; large draughts of

water in, 108 ; medical jurispi-udence of, 399.
Polypi, excision of by hemp-saw, 149.
Polyuria, case of, 394.
Pooley, Dr. J. H., letter from, 310.
Popliteal cyst, case of, 303.
Population, increase of, 17 ; of globe, 543.
Porter. Prof. Noah, notice of work by, 26.
Post, Dr. A. C, mammary tumor, 112; impalement of

bladder, 518.
Post-mortem examinations, necessity for, 449.
Precocious development, 120.

Pregnancy, spurious, feigned and concealed, 225 ; sur-
gical proceedings during, 369.
Prepuce, follicular ulceration of, 114.
Presbyterian Hospital, New York, 480.
Professions, mortality, statistics of the, 311.
Progress Medical Science, 27, 56, 83, 104, 197, 122, 251,
^275, 296, 323, 343, 367, 389, 414, 441, 466, 540, 570,

574.
Protoplasm, action of galvanic cuiTcnt on, 284.
Prout, Dr. J. S.. a new needle forceps {ilituitrated), 26.
Pruritus vulvae, 298, 444.
Psammonea, a case of, 354.
Psoas abscess, 251.

Public schools, sanitary condition of, 898.
Puerperal convulsions, statistics, 335 ; treatment of, 393,

466.
Puerperal metritis, remarks on, 15.
Puerperal thrombo.sis and embolism, 521.
Pulmonary artery, perforation of, 580.
Pulmonary consumption, 296.
Purpura hemorrhagica, 451.
Pus corpuscles, origin of, 252 ; uses of, 107.

.586

Index to Vol. VII.

Pntnam, Dr. Mnry C, on pyiomia. 7:1 ; scnrliitinous
npphritiH, •\'}i; anomalous heart. 111 ; intestinal ob-
struction, 2lW.

Pvfrmia in Rdlovup Hoxpital, 87H ; remarks on, 7:5.

','n ■ :i'.v ;ii.MinHt, 15.').

Qii:'.; tis. \. IN. ({(!.

Oil ' . .- l:ir<^e (lijscs of, 223; in homicr.inia,

li»-') ; tniniat« of, IIMI ; as parturient. I!i7, 27(i ; a
>ubstituto for. 511 ; in uterine homorrhiif^e. oil.

'■ • :.•-•», lOS.

itLs. remarks on. 29, 200.
......us and ulna, dislocation backward, 297; double

fraoture of. .jS.
Ilectal .speculum (illustrated), 363.
Rectum, plu','trinjf the, 224 ; polypus of, 347 ; speculum

for. 402 ; stricture treated by electrolysis, 209 ;

traumatic hemorrhage of (illustrated), 301.
Red coipusclos, mountinj,' of. 324.
Respirator}- diseases, chronic diseases of, 199.
Reviews and notiees of books. 19. 8(5, 110, 14(i, 203, 279.

302. 327. 3") I. 377. 400. 423.
Rhammis fraiigfular, value of. 329.
Rheumatism, influence of on character, 345 ; treatment

of. 414.
Rhode Island Medical Society, notice of, 333.
Rindfleisch. Dr. E . notice of work by. 88.
Roberts. Dr. W. C, contagion of yellow fever, 474.
Rodenstein, Dr. C. F.. cerebro-spinal meningitis. 71.
Rogers. Dr. S., on a "/<j/womj»" profes.sion, 70. 117, 249.
Rumex acetosa. poisoning by, 419.
Ruralizing, the hygiene of. 349.
Rush, Dr. Benjamin, recollections of, 170.
Russian' quarantine, 479.
Russel, C. P., small-pox statistics, 237.
Rye-straw in conjunctiva, 392.

Salaries of physicians, 96.

Salt, value of. 48.

Sand baths, 3(57.

Sands, Dr. H. B. ; naso-pharyngeal tumor, etc., 578.

San Francisco, mortality statistics of, 336.

Sandringham. medical lessons from, 39.

San Rafael, climate of the valley of, 134.

Santonine. .substitute for. 57.

Sarcoma of .shoulder. 578.

Satterthwaite. Dr. T. E., and iron cross, 376.

Saw, a folding (illustrated). 101.

Saj-re. Dr. L. A. . and the order of Wasa, 286. '

Scapula, excision of. 417.

Scarlatina, carbolic acid in. 299.

Scarlatinous nephritis, case of. 354.

Scarlet fever, prevention of, 299 ; treatment of, 466.^

Scirs, pathologj' of. ;>81.

Schoeppe. acquittal of, 399.

School, hygiene, 415.

Sclerosis utari, remarks on. 15.

Scorpion sting, treatment of. 413.

Screaming fits, infantile, cause of, 208.

Scrofulous anginae. diagnosis and treatment of. 30.

Scrotum, instrument for amputation of (illustrated),
161.

Scurvy, only in males. 105, 240.

Sea- sickness, prevention of, 4.56.

Sea-water in London, 288.

Seguin, Dr. E., notice of work by, 25 ; surface ther-
mometry, 194

Sewall. Dr. J. G.. cerebro-spinal meningitis, 265.

Sewing-machines, use of. 59, 527.

Sex of fcetus. prediction of. 417.

Shoulder, new method for dislocation of, 52.

Shrady, Dr. Geoi^e F., the drug-bill, etc.. 17, 18 ; the
department of safety. 61 ; medical colleges. 85 ;
hospital appointments, 109 ; graduation of improper

person*. 153, 253 ; the Inw against quackery, 155 ;
the late New York Hospital, 229 ; street cleaning,
301 ; medical leHson.s of Stokes' trial, 325 ; the
hygiene of ruralizing. 349 ; American Medical Asso-
ciation, 376 ; sanitiry condition of our jmblic
schools, 398 ; the .Medicnl RogiHter and the profes-
sion, 421. 445 ; our relations to our female patients,
4<i!> ; the farmingout Hystem for foundlings, 513.

Sick headache, a reniedy for. 252. '299.

Simpson. Sir J. Y. . review of work by, 146, 327.

Skene. Dr. J. C, sclerosis uteri. 15.

•Skin. nbsor]ition through. 252; grafting of, 572.

Skin diseases, treatment of. 225. 22f», 370, 412.

Skull, compound fracture of, 2!l'^.

Small-pox. chnractors and treatment of, 95, 118, 142,
KJO. 198, 23(i. 310. 365. 40.8. 419. 426. 432. 444, 456.

Smith. Dr. A. H.. laryngeal mirror in jiosition. 358.

Smith. Dr. Gouvemcur .M , on lactic acid, 329.

Smith, Dr. J. L., notice of work by. 377 ; pathological
specimens by, 36, 39, 451 . •

Smith, Dr. O. H. cerebro-spinal meningitis, 268.

Smith. Dr. S. , notice of work by, 353.

Snake-bites, treatment of, 413.

Snell, Dr A B., on American Medical Association, 426.

Snuff, lead poisoning from. 56.

Soap, brown Windsor, a<iulteration of, 287.

Soda, silicate of in ferm3ntatiou, 511.

Specialists, advertising, 376.

Speculum, a new, 402.

Speir, Dr. S. F., artery constrictor, 52, 150.

Spermatic incontinence, 348.

Spina bifida, cured, 3(i8.

Spinal cord, changes in. from division of nerves, 252.

Spine, notice of work on diseases of, 400.

Squibb, Dr. E. R., on fa,shionable remedies, 328.

St. Mary's Hospital, notice of, 359.

St. Vincent's Hospital Report, 572.

Starch bandages, modification of, 2(50.

StatLstics, yearly, of New York Health Board, 333.

Steatorrhoea tiavescens, 345.

Sterility, 197.

Stimson, Dr. L. A . letter from, 382.

Stimulants, administration of, 370.

Stokes?' trial, medical lessons of, 32-5.

Strabismus, modern operation for, 97. 115.

Stramonium, an antidote for opium poisoning, 44.

Street-cleaning department, the new. 301.

Strieker, Dr S. , review of work bv, 576.

Stricture, the operations for. 113, 151, 270, 217, 477.

Strychnia, hypodermicaliy, 348 ; tests for, 222.

Studley. Dr. Mary J., on hospital appointment, 212.

Sugar-coated pills, value of. 329.

Sulphate of iron in suppuration, 104.

Sulphur fumigations in variola, 300.

Sulphurous acid in sj-philitic ulceration. 105.

Sunstroke, notice of work on, 424 ; quinine in, 360.

Sun. physical characters of the. 417.

Suppression of urine, the result of injury to urethra,
158.

Surgical Section of American Medical Association, re-
port of, 192. 254.

Surgery, review of works on practice of, 24, 352.

Suspension apparatus, the. 256.

Sutures, none after removal of breast, 276.

Syme's amputation, utility of. 156.

Sympathetic nerve, individuality of, 392.

Syncope, death from. 1505.

Syphilis, blood in, 27. 83. 345. 415 ; character and treat-
ment of. 167. 298. 305. 346 ; aggravated form of, 528.

Syria, contagious diseases in, 359.

Talmudic gleanings, 408.

Tanacetic acid as sub.>titute for santonine, 57.

Tannin packing in prolapsus uteri, 342.

Tape-worm, in child three years, 107.

Tar, to remove, 415.

Tarantula bite, treatment of, 413.

Index to Vol. VII.

587

Temperauce in France, 428.

Teetli, replantation of, 149, 3;")2 ; exercise of, 468.

Tetanus, treatment of among Chinese, 228 ; treatment

of by excision, and chloral, 108, 299.
Tetanus cured by excision of nerve, 108.
Thapsia as a rubefacient, 106.
Theomania, 872.

Thermometers, medical, the best, 380.
Thermometry, clinical remarks on, 90, 359 ; notice of

work on, 2;').
Thigh, amputation of, 234.
Thomson, Dr. W. H. , on psammonea, 354.
Thorax, impalement of, 198.
Throat, notice of work on diseases of, 400.
Thrombosis of tibial artery, 156; puerperal, 521.
Tibia, reproduction of, 31(>.
Tic-douloureux, 296 ; by galvanism, 442.
Tonsillotomes, 2()1.

Tonsils, hypertrophied, treatment of, 367.
Tooth, fracture of, aud union of, 468.
Tractea, stricture, a case of. 234.
Tracheo- bronchitis, pseudo, 39.
Tracheotomy, cases of, 12, 414.

Transaotiens of American Ophthalmological Society, 19.
Transfusion, cases of, 236, 324.
Trephining over lateral sinus, 222 ; case of, 577.
Triplets, case of, 428.
Trismus nascentium, case of, 343.
Trueheart. Dr. C W. , on conjunctivitis, 569.
Turnbull, Dr. L., review of work on diseases of, 19.
Tuberculosis following bronchial catarrh, 36.
Tumors, injections for, 235.
Tyndale, Dr. J. H. , vaccination during the fever stage of

variola, 10.
Typhoid fever, similarity with ovaritis, 106; treatment

of, 199, 233,465, 444.
Typhus, quarantine of, 8.

Ulcers, sloughing, iodide of starch for, 105.

Ulster County Medical Society, 333.

Unscrupulous criticism. 212.

United States Marine Hospital Service, 94, 185.

University of Pacific Medical Department, 249.

University of Pennsylvania, notice of, 383.

Urajmia, acute, use of opium in, 160.

Uranoplasty, 192.

Urethra prolapsus, 299 ; rupture of, 290 ; surgery of the,
217; anatomy of, 235 ; hemorrhoids of, 381, 511.

Urethral baths, 60.

Urinary calculi in China, 44.

Urinary diseases, review of work on, 302.

Urine, diabetic, 351 ; indican in, 345 ; in malarial hemi-
turia, 197; retention of, 149, 291, 433.

Uteri, cervix, amputation of, 275.

Uterine, cloth-tents, 57 ; hemorrhage, quinine in, 511 ;
anomaly, 151 ; sound, 224, 352 ; tumor, 397.

Uteru.q, sclerosis of, 15 ; double, 528 ; removal of inverted,
200 ; fibrous, hypodermically treated by ergot, 344 ;
tannin packing in, 342 ; the surgery of, 344 ; foetal
femur embedded in, 443 ; unique case of inversion of,
443; prolapsus of gravid, 444; inverted, 513; re-
moval of, 510 ; cancer of, 512.

Vaccine virus, 296.

Vaccination during fever-stage of variola, 10 ; remarks

on, 65, 11,7, 298, 396, 398, 444,467, 468.
Vagina, membranous ca.st of, 40.
Vaginal injections, warm, iise of, 100.
Vanderpoel, Dr. S. Oakley, on yellow fever, 563.
Vanilla ices, poisoning by, 149, 391.
Varicocele, radical cure of, 416.
Variola, character and treatment of, 10, 28, 40, 190, 326,

347, 371.
Varix, injection of ergotin in, 236.
Vaso motor physiology, 190.
Venereal sores, cauterizing, 151.
Veratroida, experiments with, 128.
Veratrum al))um, hypodermic injection of, 114; proper-

• ties of, 121.
Veratrum viride, properties of, 121, 468.
Vienna, Medical Department of University of, 44.
Vol. VII. close of, 575.
Vomiting of pregnancy. 93.
Voridia, experiments with, 129.
Vowel sounds, production of, 49.

Walser, Dr. Theodore, on quarantine, 1.

Warner, Dr. John W., a case of intussusception, 530.

Washington delegates, the excluded, 182.

Waterman, Dr S. , on blood crystals, 212.

Water, vital importance of pure, 239.

Watson, Sir Thomas, work by, 351.

Webster, Dr. David, reports of Manhattan Eye and Ear
Hospital, 144.

Westchester County Medical Society, notice of, 333.

Wharton trial, the, 360.

Whitehead's, Dr. W. R., gag, 358, 403.

Whithall, Dr, S. , cerebro- spinal meningitis, 200; medi-
cal thermometry, 380.

Whooping-cough, cause of, 298 ; a remedy for, 335,

Williams, Dr. C. J. B., on pulmonary consumption, 23.

Wisconsin State Medical Society, notice of, 288.

Woman question, 174, 187 ; difference between man and
woman, 382.

Women's Medical College, 315.

Women, notice of work on diseases of, 147, 327, 377.

Worms, notice of work on, 471.

Wounds, isolating dressing of, 336.

Wood, Dr. H. C, Jr., notice of work by, 424.

Wrist, dislocation of, 296, 408 ; extension in diseases of
(ilhistrated), 143.

Wunderlich, Dr. C. A., notice of work by, 25.

Wymau, Dr. M. , notice of work by, 378.

Xylol, remarks on, 20, 329, 347.

Tear Book of Therapeutics, notice of, 470.

Yellow fever, quarantine of, 4; contagion of, 474; pa

thology and treatment of, 38 ; history of, on JVuman-

cia, 562.

CONTRIBUTORS TO VOLUME VII.

Bailey, Dr. James S., Aloany, N. Y.

Baukkr, Dr. B. Fordyck, Prof. Clinical Obstetrics,

Bellevue Hospital Medical College, New York.
Battey, Dr. R., Rome, Georgia.

Beach, Dr. Wooster, Jr., Deputy Coroner, New York-
Beard, Dr. G. M., New York.
Bell, Dr. A. N., Brooklyn, New York.
Bennett, Dr. E. P., Danbury, Conn.
Bennett, Dr. W. H., New York.
Briddon, Dr. C. K., New York.
Brockw.^y, Dr. A. Norton, Harlem, N. Y.
Bronson, Dr. E. B., New York.
Buck, Dr. Albert H., New York.
Buck, Dr. Gurdon, Surgeon to New York and St.

Luke's Hospitals, New York.
Bull, Dr. Charles S., New York.
Bumstead, Prof. Freeman J., New York.
Bunker, Dr. E. S., Brooklyn, N. Y.
Burrall, Dr. F. A., New York.
Byrne, Dr. J., Brooklyn, N. Y.

Caro, Dr. Salvatore, New York.
Castle, Dr. F. A., New York.
Chamberlain, Dr. W. M., New York.
Clarke, Dr. H. K., Geneva, N. Y.
Cohen, Dr. J. Solis, Philadelphia, Pa.
Cruse, Dr. Thomas K., New York.

De Marmon, Dr. Ph., King's Bridge, N. Y.
Derby, Dr. H., New York.
DoNNELY, Dr. M., N. Y.

Dowell. Prof Greenville, M.D., Galveston, Texas.
Dubois, Dr. H A., San Rafael, Cal.
DuFFiELD, Dr. Edward, Hannibal, Mo.
Dunning, Dr. W. B., Bellevue Hospital, N. Y.
DwYER, Dr. John, Ward's Island Emigrant Hospital,
N. Y.

FixNELL, Dr. T. C, New York.
Flint, Prof. Austin, New York.
FoRTUN, Dr. C. A., Charity Hospital, N. Y.
Frisbie, Dr. C. W., East Springfield, N. Y.

GouLEY, Prof J. W. S., M.D., New York.

Hamilton, Dr. Frank H., Prof Fractures and Disloca-
tions, and Military Surgery, Bellevue Hospital
Medical College, New York, etc.

Hayes, Dr. R. T., Yokohama, Japan.

Henry, Dr. M". H., Ed. Journal SypMhgraplxy and Der-
matohgy^ New York.

Hewit, Dr. H. S., New York.

Hudson, Dr. E. D., New York.

Hunter, Dr. W. C, New York.
Hutchison, Dr. JosErn C, Brooklyn, N. Y.

Jacobi, Dr. A., Prof Infantile Diseases, College of Phy-
sicians and Surgeons, New York.
Janeway, Dr. E. G., New York.

Knapp, Prof H., M.D. flate of Heidelberg), New York.

Leaming, Prof James R., iM.D., New York.

Lewis, Dr. Z. Edwards, West Farms, N. Y.

LiDELL, Dr. John A., New York.

Lincoln, Dr. R. S., New York.

Loomis, a. L., M.D., Prof of Theory and Practice of

Medicine, New York University, New York.
Loring, Dr. E. G., New York.

Macdonald. Dr. A. E., Small-pox Hospital, New York.

Mann, Dr. Edward C, Brooklyn, N. Y.

Mason, Prof Erskine, M.D., New York.

Mathewson, Dr. A., Brooklyn, N. Y.

Miller, Dr. M. N., New York.

Miner, Dr. Julius F., Buffalo, N. Y.

Mitchell, Dr. C. L., Brooklyn, N. Y.

Moore, Prof E. M., Rochester, N. Y.

Morris, Dr. Moreau, San. Sup. Health Dept., New York.

Munde, Dr. Paul, Florence, Mass.

Murray, Dr. Alex., New York.

Newman, Dr. Robert, New York.
NoYES, Prof H. D., New York.

Packard, Dr. C. W., New York.

Pardee, Prof Charles Inslee, M.D., New York.

Peters, Dr. John C, New York.

Peugnet, Dr. E., New York.

Pomeroy, Dr. 0. D., New York.

PooLEY, Dr. J. H., Yonkers, N. Y.

Post, Prof Alfred C, Beirut, Syria.

Prout, Dr. J. S., Brooklyn, N. Y.

Putnam, Dr. Mary C, New York.

Roberts, Dr. W. C, New York.
Rockwell, Dr. A. D., New York.
Rogers, Dr. Stephen, New York.
EossE, Dr. Irving C, U. S. Army.
RussEL, Dr. Chas. P., Registrar Records, Health Dept.,
New York.

Sands, Prof H. B., New York.
Satterthwaite, Dr. Thomas E., New York.
Seguin, Dr. E., New York.
Sew ALL, Dr. J. G., New York.
Skene, Dr. J. C, New York.

Contributors to Vol. VII.

Smith, Dr. OorvKnNKi'K M., New York.
Smith, Prof. J. Lkwis, New York.
Smith, Dr. T. Blajjch, Nyack, N. Y.
Spkir, Dr. S. Flkkt, Hrooklyn, N. Y.
Stiuson, L. a., P.iris, Frftiice.
Sri-DLEY, Dr. Mahv J., Elizabeth, N. J.

Thomas. Piof. T. rfAii.i.AiiD, M.D., New York.
InnMrsos, Dr. ItHAPKoitn S., New York.
TiUKMEAur, Dr. C. W., Gnlveaton, Texas.
Ty.vdalk, Dr. J. II., German Ilospiial, New York.

Van Geison, Dr. R. E., Greenpoinf, N. Y.
VAXDERroEL, Dr. S. Oaki.ey, Quarantine, N. Y.

"Walser, Dr. Theodore, SUten Islanil, X. Y.

Watekma.n, Dr. S., New York.

Webster, Dr. D., ^[anliattan Eye and Ear Ilospilal,

Nl'W York,
"West, Dr. II. S., Sivaa, Turkey.
"White, Dr. Francis V., New York.
WniTEHEAP, Dr. W. R., M.D., New York.
WniTTAL, Dr. S. G., New York.
WiNSLOw, Dr, John, New York.

Societies and Institutions from which Rfports have been
furnished.

A.MKRICAN Medical Association.

American Otoi-ooicai, Society.

Beli.evue no.spiTAL, Nt-w York.

Bellevue IIo.sriTAi, Medical College, New York.

CiiAuiTY Hospital, Blackw(.ll'.s Island, N. Y.

College Physicians and Surgeons, New York.

German Hospital, New York.

LoNQ Island College Hospital, Brooklyn, N. Y.

Manhattan Eye and Ear Hospital, New York.

Medical Library and Journal Association, New

York.
Medical Society, County of Kings, N. Y.
Medical Society of the County of New York,
Medical Society of the State of New York.
New York Academy of Medicine, New Yorlc.
New York Pathological Society.
Presbyterian Hospital, New York.
Roosevelt Hospital, New York.
St. Mary's Hospital. Brooklyn, N. Y.
St. Vincent's Hospital, N. Y.
University Medical College.
St. Vincents Hospital. New York.

CO.

E Medical Record

21 ^cnii-illoutljli) Journal of iUctiiciiic aiitr ^nt^cx^.

Vol. VIL]

New Yokk, Maticii 1, 1872.

[No. 1.

©rigiital Communications.

QUARANTINE REGULATIONS.
By THEODORE WALSER, M.D.,

OF NEW BlilGHTON, STATEN ISLAND, N. Y.

Read at a Stated Meeting of the New York Academy of Medicine, Febru-
ary 1, 1872.

In considering the quesdon of Quarantine, I am con-
scious I am addressing the elite of the medical profes-
sion — men familiar ^vith the literature, aetiology, and
modus propagandi of every disease that comes under
its provisions ; and I shall limit my observations, there-
fore, to personal experience on a field which is compa-
ratively foreign to the student of Hygiene, and in treat-
ing the history of epidemics in New York City, merely
refer to them as the causes Avhich prompted the fram-
ing of new laws and the initiation of further quarantine
restrictions. Tou will be pleased, therefore, to bear
with me if I speak of these hws as an integral part of
the question before us, and, in summing up the experi-
ence of canturies, make this experience the basis on
which to decide the claims of quarantine.

Appalled by the gradual approach of the epidemics
of yellow-fever, which had caused such fearful devasta-
tion in Charleston and Norfolk during previous years,
the first quarantine laws were enacted in the colony of
New York by the Lieut.-Governor, Council, and General
Assembly in 1758, enacting that " all trading-vessels,
transports, and others, having small-pox, yellow-fever,
or other contagious distempers on board ; and all per-
sons, merchandise, and goods whatsoever, coming or
imported in such vessels; and all vessels coming from
any place infected with distempers, shall not come into
any of the ports or harbors of this city, or nearer to it
than the land commonly called Bedloe's Island, and shall
be obliged to make quarantine there, or in such other
place or places, for such time and in such manner as
the Governor, or Commander-in-chief, by and with the
advice of His Majesty's Council, shall deem proper and
reasonable to direct and appoint ; and until such persons,
goods, or merchandise shall have respectively performed,
and be discharged from, such quarantine, no such per-
sons, goods, or merchandise, or any of them, shall come,
or be brought ashore, unloaded, go, or be put on board
of any vessel within this colony, or the neigliboring colo-
ny of New Jersey, unless they shall first be permitted
and licensed by order of the Governor or Commander-
in-Chief for the time being, by and with the consent
of the Council ; " making the penalty of infiingement of
this Unv £200, and £20 if any infected person Avas
found on board of any vessel without due notice, or if
any pilot refused or neglected to obey the provisions
of this law.

Whatever may have been the preventive course pur-
sued, no epidemic or disease of any alarming character
occurred in New York from this date, although Dr.
Chisholm remarks, " that the smell from the ships was

in the highest degree offensive, and the police at that
time by no means efficient, and putrid substances of
every description were accumulated in the siiips and
every part of the city."

In 1784 it was enacted in the Senate and Assembly,
that all vessels having on board any persons infected
with yellow-fever, or any other contagious distemper,
or coming from any place infected with such conta-
gious distemper, shall not come into the harbor or city
lower than Bedloe's Island, and shall perform quaran-
tine there for such time and in such a manner as tlie
Governor, or, in his absence, the Mayor of the City,
may direct ; and that during such quarantine no person,
goods, or merchandise shall be permitted to leave the
vessel without the permit of the Governor, or Mayor,
of New York. The law further defines the duties of
masters and pilots, applies the penalty exacted, as be-
fore, for the benefit of the hf;hthouse at Sandy-liook,
invests the Governor with the right of appointing a
physician, and specifies his duties, privileges, and com-
pensation.

Yellow-fever prevailed in New York after this to
a greater or less extent every year. Of the epidemics
of 1791 and 1703 no further account is given than
merely stating the number of its victims, and the lo-
calities, streets, and wdiarves where it prevailed. Its
origin in 1795 is, however, clearly traced to the brig
Zephyr from the West Indies ; Dr. Treat, the examin-
ing surgeon, being its first victim — as is supposed from
making an autopsy of a death on board on the day of
her arrival in port. Being permitted to go to the wharf,
foot of Dover street, she hauled alongside the ship 117/-
liarns from Liverpool, where the disease first appeared
among the crew, and a few days later in White near
Dover street, extending thence to the adjacent build-
ings and streets. Every effort was made by Dr. BaiJy
to contradict this statement ; using as the strength of
his argument that no one of Dr. Treat's attendants and
friends was taken sick, and hence it could not have
been the yellow-fever. Indeed, the idea of personal
infection had so overshadowed the intellect of the
profession, that the most important facts were over-
looked in the vain search of evidence for it. In
the mean time the TIankey brought the disease from
the coast of Africa to New Granada, arriving on the
18th of March. In the middle of April the disease as-
sumed an epidemic form on the Island ; during June
and July it swept over the entire Island. Erom New
Granada it was carried to St. Domingo and Jamaica,
and thence to Philadelphia, by clothes, and more es-
pecially the woollen jackets, of diseased sailors. "Ves-
sels from Philadelphia Avere now quarantined in New
York.

In 1796 the first Health Oflicer and seven Commis-
sioners of Health were appointed, and their duties de-
fined. All vessels wMth forty or more passengers from
any foreign port were made subject to quarantine ;
the Governor of the State was authorized to issue
from time to time proclamations designating the ports
from which vessels should be quarantined, and the Health
Officer or Health Commissioners were authorized to bring
vessels already at the wharf back to quarantine, and to

TILE MEDICAL RECOKD.

anchor wheresoever they might direct. £2,000 were
nppropriatetl to orcct a Lazaretto on Governor's Island
for the reception of infectious diseases, and placed under
the charge of the Health Ofliccr, and a further sum of
£2,000 was iipproj)riated for its maintenance. It was
then maile oblii,'atory upon every practisin-,' physician
to report I'ach case of infectious and contagious disease
10 the lleallli Commissioners.

liy the laws enacted in 1798 the apppointment of
Health Ollicer and Commissioners of Health, and their
respective duties, were still further defined ; all vessels
having or liaving had on board any case of lever, or
coming from a port where such fever prevailed, being
made subject to quaraniine, unless they had been pre-
viously in any of our northern ports for a period exceed-
ing ten days.

Dr. I'nderhill gives the following account respecting
the epidemic of yellow-fever which followed in the same
year:—

" Some time in July the ship Fame is said to have
arrived from one of the West Indian islands, and come
to the wliarf below New Slip, where she lay for some
lime. About the tliird or fourth of August some people
went to discharge her ballast and to pump her out.
Among the ballast was a quantity of damaged coffee,
extremely putrid, which, with the water discharged
from the pump, was so oUensive to the smell tliat the
neiglibors were induced to shut their windows, espe-
cially while eating. About the sixth of the month, a
party dined at the house of a Mr. Mead in the neighbor-
hood, all of whom were taken sick in their respective
residences, on the fifth day afterwards, of yellow-fever,
and several of them died. The next house above was
visited in the same way ; three of the inmates were
t^ken sick at the same time, two of whom died. In the
second and third houses the inmates shared the same
fate." The number of deaths from yellow-fever during
this epidemic exceeded 2,000; wbilein Philadelphia the
ravages of the disease were still greater, and, as in New
York iu the case of the ship Fame, were clearly to be
traced to the Deborah and Mary from the Spanish Main.

Ajipalled and now full}' conscious of the danger, and
looking to an efficient quarantine as the only safeguard
against its importation, in 1790 the healtli laws were
so amended as to constitute the Health Officer Resi-
dent Physician, and members of the Council the Com-
missioners of Health, with the power to purchase a
tract of land on Staien Island for a boarding station
and marine hospital. The eastern shore was selected,
and some of the buildings were occupied during the
autumn. The list of ports from which ve.-selswere sub-
ject to quarantine embraced now all foreign and do-
mestic ports south of Georgia, from the 31st of May to
the 1st of October. In 1799, while the authorities were
still groping in gutter;, and sinks for the origin of the
disease, we find that seventy-four ca.ses of yellow-fever
were sent from the city to the Marine Hospital, the dis-
ease being confined to Old Slip and the vicinity of the
East Iliver.

In 1801 the Health Officer, Health Commissioners,
and Resident Physician to the Marine Hospital were
constituted the Board of Health of New York, and for
the first time the introduction of cargoes and nifrchan-
dise from infected vessels into the city of New York
was prohibited. Cargoes from infected ports had to be
discharged by lighters, and the vessel cleaned and
fumigated before pratique could be granted. Over
seven hundred cases of ship-fever were admitted dur-
ing the same year, comprising among the number over
one-third of the pa.ssengers of a brig from Sligo, arriv-
ing at this port after a long passage, in a destitute and
almost starvinsr condition.

In 1803, out of 1,G00 cases GOO died of yellow-fever,
commencing in coflTee-honse .slip and its vicinity. The
source is not given l^y any existing record. Nor can
the epidemic of 1805 be traced to positive infection
and importation of any one vessel; and to attribute it
to the landing of a quantity of rags from Leghorn is
perhaps as eironcous as the as-sertion of the Health
Officer, that it did not ari.se from any neglect at qua-
rantine, or come through that channel. The law pa.?.sed
in L'-'Ol, providing that no vessel from infected ports
should approach nearer the city than three hundred
yards, seems tiien to have been a dead letter.

In 1811 the quarantine laws were revised, and vessels
from Asia, Africa, and the Mediterranean, and from any
port south of Georgia, the Bernuidas, Bahamas, and
the West Indies, and all others having forty or more
passengers on board, or having had sickness or death
while in jiort or on the passage, were made subject to
quarantine during the year; and all vessels from Am-
erican ports south of Cape Henry were made subject
to it from the 30th of May to the 1st of October. Ves-
s.'ls with yellow-fever or any other pestilential disease
onboard, or hailing from ports where yellow-fever pre-
vailed, wore to be unloaded at quarantine, cleaned and
whitewashed three times, and to remain at least thirty
days in quarantine. No passenger or sailor was per-
mitted to proceed to New York until twenty days after
the occurrence of the la«t case of pestilential di.sease.
Vessels from the West Indies, Africa, and South of
Georgia were to remain but four days at quarantine 'to
discharge tlieir cargoes by lighters, and under no cir-
cumstances approach nearer the city than three hun-
dred yards ; and crafs considered to be dangerous to be
removed from the city to the quarantine grounds; car-
goes of hides, wool, and cotton to be landed at the
public stores at quarantine.

New York remained exempt from the visitation of
any contagious disease during the war Avith England
and until 1819. when a few cases of yellow-fever occur-
red near Old Slip; but by the vigorous exertions of the
Board of Health and the blessing of divine Providence,
its spread was averted.

In July, 1822, the first case of yellow-fever occurred
at the foot of Rector street, attributed to cargoes landed
from the Sjjanish Soldier and the Eliza- Jane from
Havana, although, as usual, its source was sought
in churchyards, gutters, and sinks. A fact not to be
overlooked is, however, that the same vessel which car-
ried yellow-fever from Key West to St. Augustine, and
was the prolific source of the epidemic in St. Augustine,
was overhauled at the foot of Rector street, and two of
the employes, and five who visited them, were among
the first victims of the disease. Of five hundred who
had the disease in this year, two hundred and fifty-five
died. With this terminated the last of the yellow- fever
epidemics, occurring during a period of more than half
a century.

The quarantine laws, as last amended, remained near-
ly the same until 1830, when an act was passed,
permitting healthy persons arriving in vessels from
infected ports to proceed to the city, but without bag-
gage.

In August, 1831, the Board of Health were first con-
vened to consider the quarantine of cholera, and a com-
mission was appointed to confer with the President,
and to memorialize Congress to institute a national
quarantine, and aid the authorities of New York in
protecting the public against the dreaded visitation of
cholera. In response, a communication was received
from the General Government, surrendering the use of
Fort Lafayette as a depot for goods. A resolution was
adopted to land all goods from Russia at the Fort. To

THE MEDICAL RECORD.

Ibis was added, at a later meeting, all merchandise from
Hamburg and Smyrna.

In January, 1832, tbe appointment of a sanitary com-
mission under the auspices of the Greneral Government
was solicited, whose duty it should be either to send
some of their own members or other agents to the ports
of Europe or Asin, where the disease prevailed, and to
collect facts relating to the means of prevention, and
remedies to be applied in cases of the disease. In April
and June further preventive laws were enacted, and
§500 were applied to the purchase of chloride of lime.
On the 2d of July twelve cases were first reported to
the Board of Health, and a proclamation was issued,
assuring the public that the disease was not personally
communicable. By the 18th of July the number of
deaths from cholera exceeded six hundred. Tiie chole-
ra epidemic of 1832 first appeared in Quebec. A law
subjecting to quarantine regulations all vessels from
ports of Upper and Lower Canada was passed in 1833,
and has remained in force until the present day.

In 1845 a commission was appointed to revise the
quarantine laws, but without any special result.

In 184S a number of infected vessels, government
transports from New Orleans and ^lexico, were anchored
oflF the old quarantine grounds. After an easterly
wind, a quantity of refuse material from these vessels
drifted ashore, lodging in Stapleton Basin. In less
than a week following, two cases of yellow-fever oc-
curred in the nearest dweUing, and then extended to
the adjacent dwellings, and prevailed as an epidemic
for half a mile along the shore. Visitors and nurses
were attacked ; but returning to their own homes in the
interior, the disease remained confined to themselves-,
although surrounded by their families, and in localities
much more favorable to the generation and develop-
ment of miasmatic or contagious diseases than the
place where they became infected.

In 1849 §50,000 was appropriated, and a committee ap-
pointed to efi'ect a removal of quarantine to Sandy Hook.

In 1855, the year of the memorable epidemic of
yellow-fever in Norfolk, Va., New York remained ex-
empt from a visitation of the disease, and but few cases
were admitted from shipboard.

In 1856 the quarantine laAvs were again revised;
new and special power was granted to the Health Offi-
cer, and by an adroit transposition of the figure 3, the
coastwise quarantine was extended from the 1st of
April to the 31st of October, instead of from the 30th
of April to the 1st of October; and after the different
ports of the West Indies, Mediterranean, and coast of
Africa, from which vessels were subject to quarantine,
"all other ports" were sandwiched in, by which the
Health Officer's income was increased from $6,000 to
$10,000 per annum.

The epidemic prevalence of yellow-fever at Fort Ham-
ilton, on the shores of Staten Island, and on Governor's
Island, during this year, has been so ably and recently
described by Dr. Harris, that I need not refer to it.

In 1858 the quarantine hospitals were destroyed,
and then an entire change of quarantine regulations
was initiated. The Commissioners of Emigration, the
legal custodians of the quarantine hospitals, were super-
seded by Quarantine Commissioners in 1859, and §50,000
were appropriated to defray their expenses. The
"Floating Hospital," constructed from the hulk of an
old ocean steamer, was anchored in the Lower Bay
for the reception of yellow-fever patients, and as a
boarding station for the c^uarantine of vessels from the
West Indies, coast of Africa, and American ports south
of Georgia.

In 1861 an additional appropriation of §43,000 was
made, and —

In 18G3 the quarantine laws were so revised as to
give the Health Otticer additional powers, even to the
destruction of cargoes and the submersion of vessels.
The employ6s, stevedores, and lightermen were to be
selected by him, but their compensation was fixed by the
Commissioners of Quarantine, who were also by this
act constituted a Board of Appeal.

In 1864 a further sum of §80,000 was appropriated.

In 1865 the quarantine laws were again revised,
but without making any material change; $49,000 ad-
ditional were appropriated.

In 1866 the Mayors of New York and Brooklyn, in
conjunction with the Commissioners of Quarantine,
Avere empowered to construct permanent quarantine
buildings in the Lower Bay, and §400,000 appropriated
fur that purpose. The sale of the old quarantine
grounds, with the exception of a boarding station, was
ordered, and, by concurrent resolutions, the general
government petitioned for hulks and vessels for tem-
porary quarantine purposes.

In 1867, besides further appropriations of §132,000,
temporary accommodations for the reception of passen-
gers under quarantine were ordered to be made on
" Barren Island," and the west end of Coney Island
selected for a boarding station; but during the follow-
ing session in '68 this law was again repealed, and no
further enactments passed by which the quarantine reg-
ulations were materially modified.

Over §300,000 have sinc3 that time been appropriated
for the maintenance of quarantine and the construction
of buildings on the island in the Lower Bay. under
the law of 1866 ; only the lower one is prepared to re-
ceive patients, while the upper one remains unfinished,
and may come "handy." but is certainly erected with-
out special design or purpose.

In reviewing the history of quarantine, and the
various laws enacted to protect the community from
the introduction and prevalence of contagious diseases,
we find that every progressive measure was prompted
, by a sense of the insufficiency and insecurity under ex-
isting laws, and the modification and change of medi-
cal opinion in regard to the mode of emanation and
i propagation of the disease. The quarantine had been
removed from Governor's and Bedloe's to Staten
1 Island, and each one in its turn abandoned. At first
it was only intended to protect against yellow-fever
I and small-pox. The swelhng tide of emigration, and
the prevalence of typhus amongst the masses, intro-
duced the last-named disease as the most prominent
danger to be guarded against. Then cholera, appalling
and tearful in its destructive march over the continent,
called for new and energetic measures of self- protection.
And so, patch upon patch was added, meeting each
I contingency, and providing for ever}^ successive emer-
gencies ; each disease in its turn engaging the attention
I of law and medicine, as the danger from its ravage.?
I appeared more imminent. The range of ports from
' which vessels were subject to quarantine was gradually
! extended, until it finally included all vessels from all
foreign ports, and all coastwise vessels from domestic
ports south of Cape Henlopen, from the 1st of April to
the 31st of October.

Before we consider the mode of propagation and the
quarantine of each disease, permit me first to cast a
glance upon the topography of port? from which ves-
sels were subject to quarantine in the harbor of New
York. I have already mentioned how strangely and
surreptitiously " all other ports" have been smuggled in
under the laws of 1856. What are the diseases which
possibly can excuse a quarantine of merchant, vessels
, from any of our northern ports ? Why are vessels from
i Nova Scotia subject to sanitary restric; ions from which

THE MEDICAL RECORD.

Maine is exempt? and liow is it that vessels coming
iliruufrh llu' sound ni;iy and do onlfr New York
Harbor at all seasons, while vessels puissinp to llio east-
ward of LoDfj Island are subject to visitation ? Are
tliere any professional frrounds whatever justifying
this restriction or infringement on conuneree? The
same may be said of merchantmen from the west of
Kuropc, whid), prior to this interlineation, were not
subject to quarantine nnless having passengers on
board. And yet only a slight, a very slight diancc
exists of disea<e |)revailing in their ports of Qi|)arturc
of which we will not have been apprised; for at an
age when we have daily communication with all the
world, this can scarcely happen. What can warrant a
(piarantinc from the Potomac, from WashingtuM and
Haltimore, whi h does not apply equallj' well to I'hila-
(ielpliia? During thirteen years' service in quarantine,
1 know of only one instance of sickness coming from
any of these vessel.^, and that was a passenger from the
interior. Fruits and vegetables, oysters and coal from
A'irginia, are certainly cargoes which require no quar-
antine, and I mention this because every quarantine
restriction is supposed to rest on medical ground.

YELLOW-FEVER.

The history of yellow-fever has been so thorougldy
interwoven, and was in fact so much the originating
cause of quarantine, that it is not my intention to occupy
your time with the recital of a subject so familiar to all
present, but at once proceed to the consideration of
quarantine regulations respecting this disease in the
port of New York, studiously endeavoring to limit my
remarks to the professional merits of the question.

As an cllicient quarantine can only be based upon a
thorougii knowledge of the modus propagandi of the dis-
ease, and as this can be our only safe guide between
inefliciencv on the one side, and unwarrantable exaction
and restrictions on commerce and intercourse on the
otlier, I must invite your attention to the consideration
of the

I. Xature and characteristics,
II. Meaiui and mode of portation,

III. Mode of infection in yello"\v-fever, and

IV. T/ie quarantine reyulaiions now in use. and neces-
sary to prevent the introduction and prevalence of this
disease in the port of New York.

I. Character and Xatin-e of Yellow-Fever. — As long
as we are unable tangibly or ocularly to demonstrate the
biopla.«ma, or disease germ, or actually know what con-
stitutes the morbific cause of the disease, we must con-
tent ourselves in its conception with analogy and infer-
ence, and by this we are unmistakably led to believe
that the yellow-fever virus is of cryptogamic origin.
This theory assumes practical form when we consider
the chemical action of fungi of all kinds upon the
air; their subsequent deleterious influence upon animal
life; and the conditions of their generation and growth
— heat, moisture, and darkness, with their corresponding
meansof extermination— air, thorough ventilation, light,
and cold. As time will not permit us to enter upon
theories, and as facts alone can be considered a safe
basis on which the study of the character and nature
of yellow-fever can be prosecuted, we mention, as its
first and most prominent law of existence, a continued
temperature of So"" and over. Exotic in its origin, in-
digenous only to the tropics, yellow-fever cannot exist
in our latitude except during the summer months, and
with the advent of every frost becomes exterminate.

With Dr. Rush the last advocate of the domestic
origin of yellow-fever has passed away; and not only
in New York, but scarcely in any of the gulf ports can
a man of eminence be found who is not convinced that

yellow-fever cannot originate de novo in any ports of
the United >Slatea, but is always the result nf impurt'ition
from abroad. During the war the mo.'t ii;.«alubriou8
ports remained exempt from its visitation, and this less
on account of an eflicienl quarantine, or inUjrmd sanitary
regulations, but becau'^e commerce and intercourse
with infected districts was partially or entirely cut off.
II. If not indigenous, yellow-fever is necessarily a
portable disease, and its portation must either be

a, /'// jtersons laboring under the disease, and repro-
ducing the morbific germ ; or,

b. by things, f /miles, ship-s, merchandise, p<;rsonal
effects, transmitting the germ in its maturity.

a. liy persons. — The difficulty ofseparating effect from
cause, and our inclination to draw our indications from
the visible, perceptible, and tangible, have necessari-
ly led tiie inquiring mind to look to the yellow-fever
patient as the meansof portation and communication,
and thus to overlook the most important facts connect-
ed witii the transmission and development of the dis-
ea.se. A clear interpretation of the experience of a
century, and much negative evidence prove, however,
beyond a doubt, that persons and their eliminations
have 110 agency in tiie matter ; for not a single case can
be traced beyond the source of infection, though thou-
sands have fled during every epidemic from the stricken
district, or tlic exposure to fomites, to be nursed and
cared for where prior to their arrival no case of the
discTse existed.

From the opening of the Quarantine Ho.spitals in
1798 to their destruction in 1858, over 1,200 ca.ses of
yellow-fever were treated, and not a single instance is
on record in which the disease was communicated from
the sick and their eliminations, to patients admitted
with other diseases ; while the introduction of cholera
was almost invariably followed by the development of
similar cases among the other patients. Over 200
patients have since been treated in the Floating Hos-
pital, and yet not one of the employes ever took the
disease. Assuming, then, as an incontrovertible truth,
that persons cannot be the carriers of yellow-tever viru.«,
it necessarily devolves upon inanimate matter — vessels
and fomites — as the only remaining media of transporta-
tion from its original or acquired liabitat. I may cite as
evidence in proof, the history of every yellow-fever
epidemic, both on this continent and in Europe, in
which the disease could be traced to these things alone,
although local causes may have contributed to its incep-
tion and development.

b. By thinys. — That vessels may become infected,
and the floating habitat of a local epidemic,' is corro-
borated by the experience of every year, and the only
questions before us are : Its source, or the condition
of the port of clearance requisite for, and the condition
of vessel and fomites favoring, the inception and infection
by yellow-fever virus.

Ports. — Yellow-fever may prevail as an epidemic,
appalling and intense, or the occurrence of a few spora-
dic c;iscs may simply indicate the presence of the virus ;
although the former almost insure infection, the latter
by no means excludes the possibility. The Alabama
was infected by yellow-fever at Key West.where its pre-
sence was not even known to the commander. The port
may be land-locked, surrounded by swamps and decay-
ing vegetable matter, as at Havana ; or an open road-
stead, as Campeche, Tampico, and the probabilities of
infection may be correspondingly less. Again, the
vessel may be loaded by lighters, or at the wharf, the
former not excluding, the latter certainly fovoring, the
probabilities of infection.

Vessels. — Old vessels are invariably more liable to
infection than new ones, to whatever we may attribute

THE MEDICAL RECORD.

this predilection ; and that a local cause exists we may
infer from the fact that we have vessels of bad repute,
once the habitat of infection, and under ?iniilar circum-
stances more than likely to be again, although others
may escape. The James H. GHddev, Julin I/iilleck, and
Susquch((H7ia, are instances ; in each yellow-fever had
prevailed repeatedly. Repeated observations also show
that human eflluvium favors the infection of vessels with
tlie specific virus of this disease, as it does the occu-
pants of crowded passenger ships and prisons with t}'-
phoid. Yellow-fever occurs much more frequently on
board of men-of-wnr than in any other class of vessels,
notwithstanding the severe and constant attention to
cleanhness and ventilation which the sanitary discipline
imposes. The names of the Buzzard, Enterprise, 8us-
(jiteluutnii, Ahhnna, and Tahoma stand pre-eminent
in om- quai'antine records of yellow-fever. B}'' a pas-
senger ship the disease was first introduced into the
West Indies. Tlie ship Dehorah, aBritisli transport from
St. Thomas, carried the disease in 179S to New York ;
and the only infected vessels which arrived here during
the summer of 1862 were Coolie vessels, which had dis-
charged their living freight in Havana, while not one
of the Havana packets or ordinnry traders appears to
have suffered by the prevailing infection of the Port.

Fomites. — Tlie portation of yellow-fever virus by
fomites, by railroads and other conveyances than infect-
ed shipping, cannot be the subject of quarantine regula-
tions, and is of at least questionable occurrence. During
the terrible epidemic in Norfolk, thousands came by
rail to every city in the union, and I am not convinced
of the occurrence of any case from persons or things
brought thence.

III. Mode of Infection. — Yellow-fever may extend
from the infected vessel —

1. B]! contifiuitij,

2. Bij winds,

3. Bij fomites.

1. By contiguity. — To the law of contiguity we
may attribute the prevalence of every yellow-fever
epidemic in New York, commencing invariably in slip?,
docks, and streets nearest to tlie focus of infection,
until the approach of infected vessels was prohibited by
laws, and in its efficient administration the introduction
and prevalence of the disease prevented. What may
still occur in the absence of such preventive measures
we may infer from the history of St. Nazaire, in France,
in 1861, when the Anne Marie arrived from Havana,
having lost two of her crew by yellow-fever. On board
of three vessels moored close to her the crew sick-
ened in the order of their proximity not only, but
while the vessel moored nearest to her lost four out of
five, the third lost only one in seven other crew.

2. By winds. — Whatever may be tlie nature of yel-
low-fever virus, its specific gravity is obviously greater
than air, — as this alone can fix it to the vessel, — and vir-
ulent in the degree of its density. The lower the stra-
tum the more poisonous its influence. That by dis-
charging and ventilating, the virus is dislodged and set
free, we see in its effect upon the lightermen receiving
cargo or ballast, and persons bathing in the immediate
vicinity of discharging vessels. The extension of this
virus so liberated, and by its specific gravity floating on
the surface of the water, certainly cannot be limited,
except by attenuation ; and if theformntive elements are
found upon the water, or, drifted by wind and wave
on shore, it finds the matter or formative element on
shore, it will, under circumstances resembling its tropical
habitat, necessarily generate and develop. The epi-
demic on Staten Island in 1848, on Long Island and
Staten Island in 1856 and 185S, each occurring after
continued winds from the fleet of infected vessels, may

be solely attributed to this mode of infection ; while
the epidemics on Governor's Island, occurring in 1856,
1858, and 1870 in the same locality, the point nearest
the Atlantic dock, where cargoes from vessels at qua-
rantine were constantly received, was unquestion-
ably due to the liberation of yellow-fever virus from
these cargoes drifting on the surface, until it found on
the shores of the island, or the df'biis floating near its
shores, the requisite formative elements. This drifting,
as snow in winter, may also account why a fence, a row
of dwellings, an artificial barrier will arrest the progress
of the disease ; and why tlie north side of llotten Row
suffered while the south side remained exempt; on
Staten Island the houses fronting the bay were infected,
while others adjoining,fronting inland, remained exempt.

By fomites. — These may be either materials Jloating
NEAR, or the cnrgo, dunnage, and personal effects from
the infected vessel.

We have unquestionably in the floating material the
most prolific source of infection. This may or may
not be from the infected vessel, but debris, decompos-
ing porous substances constituting the formative cle-
ment for the floating virus, imder circumstances most
closely resembling its tropical habitat.

The straw taken from the Bay by the first victims on
Fort Hamilton, the mattress at Gowanus, were such;
though neither could be traced directly to an infected
vessel.

Cargoes. — To prove the infection by cargoes is ex-
tremely difficult, because isolated cases are apt to be
misunderstood, or hushed up under the apprehension ot
public alarm, or reproach for ofBcial negligence. In
1822 the epidemic was attributed to a quantity of su-
gar stored at the foot of Rector street. Custom-house
ofticers were reported sick of yellow-fever while em-
ployed at the Atlantic Dock, Brooklyn, in 1856; and
Sleight, a custom-house officer not connected with
quarantine, is said to have died of yeflow-fever in
1848.

The law makes distinction in cargo and the charac-
ter of "fomites" liable to carry disease, which is per-
haps not wliolly based upon "facts. Rags, unwashed
and from an infected port, may certainly be potent car-
riers; and as the history of the J. II. Olidden teaches,
a prolific source of infection, as also hides and animal
remains. On the Chr. Martell seven out of twelve
employes sickened, who had carried the partially de-
cayed sheep-skins on deck. But few cases are known
where general cargoes and the products of the tropics
proved injurious, unless in a state of decomposition.

Dunnage and Personal Effects. — That dunnage from
the hold of an infected vessel may carry the virus we
have the evidence in the Susquehanna. A Watch-
man (?) slept in the folds of a sail removed from the
hold of the ship the previous day ; he sickened in five
days, and died of yellow-fever.

That the virus may be carried a great distance by
personal effects we have in evidence the well-known
instance of the chest of clotliing carried from Martinique
to New Haven, in 1794; the clothing of a dead sailor,
washed in Lombardy St., in 1822, and infecting all pre-
sent; the disease of the Sinclair family in Quarantine,
in 1848, attributed to the clothing of stevedores sick
with yellow-fever; and, more recently, the case of the
mate of the Cravford, who went from a vessel, which
subsequently proved infected, on board of another, out-
ward-bound, the captain of which sickened three days
after he slept in the bunk above the one containing the
mate's clothing — in every instance the effects came
from localities positively infected, without being opened
and ventilated, and carried to localities favoring in-
fection.

THE MEDICAL KECORD.

After careful considiTation of the natiiiv of yellow-
fever, conclusively proving its exotic origin, nnd that
it c.innot occur in our latitude unless carried by vessels
and fviniiU'S, the condilions of infection of vessels
abroad and the means of conveyance to our shores — the
quarantine measures to prohibit the introduction and
prevalence of the disease is the question of tliC great-
est iinporlancc.

The Quarantine of Yellow- Fever. — By law all vessels
from any i)oint south of Georgia, the coast of Africa,
and the ^lediterra'.lean are boarded from the hospital-
ship, anchored about three miles below tin; Narrows.
Upon examination of the bills of health, the sanitary
record, and the present condition of pasoengers and
crew, immediate prutiiue is (/ranted, or the vessels are
detained to remain under observation, or perform
quarantine. Inmiediato pratique is only granted if no
])retoxt wliatever exists to retain the vessels. I use
the word pretext purposely ; fir as long as the Health
Officer is the beneficiary of his own acts, and every
vessel quarantined is a source of revenue, as during
the past few years, it is scarcely to be presumed that
he will lean towards the master of the vessel, anxious
to end his cruise and join his home, who finds even a
few days' quarantine very irksome.

The quarantine of observation applies to all vessels
coming from any port suspected of being infected, or at
any time the seat of an epidemic, and implies a qua-
rantine of from two to five days, opening of hatches,
ventilation, and fumigation — provided the placing of
half a dozen plates of black oxide of manganese, chlo-
ride of sodium, and dilute sulphuric acid merits the
name of fumigation.

If the sanitary condition of the port of clearance is
more questionable, or the cargoes of such a character
that it belongs to the first class, as designated by law,
the quarantine is extended from ten to fifteen days;
and should the suspicion amount to positive evidence
that sporadic cases occurred in the port of clearance, or
any port where the vessel stopped on her homeward
passage, the vessel is detained either with her own
crew or with a crew of ship-keepers, for a period of
from twenty to thirty days ; and only if all remain
well, and later reports from the port of clearance show
that yellow-fever is not epidemic, the vessel receives
stream permit, or direction to discharge on an isolated
dork or irarehouse.

It will be remembered that by the laws of 1805 vessels
suspected of being infected were prohibited from com-
ing nearer the wharf of the city than 300 yards ; and
the '■ stream perfliit " is unquestionably yet in obedi-
ence to tliis ancient law, and certainly one of the best
provisions whenever a question as to the sanitary
condition of the vessel exists. " Isolated stores and
warehouses " is of course a relative term ; the stores
especially mentioned are, however, the west side of
the Atlantic Stores, Brooklyn, which, surrounded by
water and built of stone, and at least ha'f a mile from
any dwelling, offers lacilities of isolation and compara-
tive security which no other presents. Should Robin's
Reef be built up by stone, as granted by tlie Legisla-
la!ure, it would of course supersede the Atlantic bock
for all quarantine restrictions.

A vessel arriving from a port declared to be infected,
by foul bills of health or private information, is suspect-
ed of being infected, though all are well and have been
during the passage. After a few days' quarantine she is
discharged by licensed stevedores and lighters, and no
pratique granted until sufficient time has elapsed to
prove, by the continued good health of the employes,
that she is not an infected vessel.
By the discharge of vessels we have not only thor-

ough ventilation, efficient means of disinfection of ves-
sels and cargo, but, in the continued good healtii of a
number of unacclimated employes, exposed lo tiie virus
umler the most unfavoraljle circumstances, a number
of negative evidences amounting lo positive assurance
that the vessel is not an infected ves.sel.

From the same port vessels may arrive, on board of
which cases of yellow-fever may have occurred while
in port or on tlie iiassa;^e, but no cases after the fifth
day of her di-parture; ^he may be an infected vessel,
but no positive evidence is adduced, since all her cases
may be traced to the port of clearance ; she is treated
in the same way, receiving jiratique only after every
evidence manifests her sanitary condition.

Another vessel arrives with new cases of yellow-fever
occurring si.x and more days after leaving port, or even
after her arrival in New York Bay ; she is quarantined
in the Lower Bay for thirty days after the occurrence
of the last case, then discharged by lighters, her cargo
only receiving conditional pratique, .and the vessel only
alter every evidence that she is no longer an infected
vessel. When, however, this evidence confirms that she
is and remains an infected vessel, she is quarantined till
frost, her only solvation.

A difficulty arises in the treatment of vessels in bal-
last ; in this ca«e ship-keepers are placed on board, the
vessel is cleansed, and the ballast moved by persons un-
acclimated to the disease, and the vessel treated as
others.

Thanks to a manifest Providence, by this course not
a single case of yellow-fever occurred in New York or
harbor while Dr. Gunn was Health Officer, although
over 500 vessels arrived from infected ports, and 10
vessels were declared positively infected, being refused
pratique until after the middle of October.

It willihus be seen that the percentage of infected
vessels in vessels coming from infected ports is only a
little over two per cent., or rather that the ordinary meth-
od of disinfection by ventilation and fumigation suffices
to eradicate the virus of the disease, or, by extreme at-
tenuation, renders it harmless.

It may appear strange that no provision should exist
in our port for these positively infected vessels; but as
frost alone exterminates the virus, and any other meth-
od would necessarily entail loss of life, quarantine till
frost is after all the only safe method, and more readily
submitted to b}' masters and owners than exactions
which they deem frivolous and unnecessary.

Disinfection of vessels. — Frost alone can positively
eradicate the disease, and to apply this so as to bring
the temperature on board the vessels below the freez-
ing point during the summer months is difficult, but
by no means impossible, and only a few abortive
trials have been made during the administration of Dr.
Gunn.

Ventilation of vessel and cargo may, and, as our experi-
ence proves, will, fti a measure, disinfect vessels, for we
know that by discharging of cargo or ballast the virus
I is liberated, and vessels showing the most positive
proofs of being infected on arrival, in the course of
time give sufficient negative evidence to doubt longer
that she is an infected vessel ; but neither white-wash-
ing three times, as under former laws, nor fumigation,
nor ventilation, nor even scuttling, will positively dis-
infect an infected vessel.

Fumigation. — The very method of fumigation as now
employed in quarantine shows the utter contempt for
this method of disinfection, and I doubt very much if a
medical man can be found who believes that chlorine,
to the amount used on board of these vessels, can have
any effect whatsoever in the disintegration of the virus;
and neither bromine nor carbolic acid, nor any other of

THE MEDICAL KECORD.

our disinfectants, can really prove more than mere aux-
iliaries in llie disinfection of vessels.

Tlie Upi^er and Loicer Bay as Quarantine Slations. —
The detention of vessels at the Lower Quarantine, both
while under observation and quarantined as suspected
or infected vessels, commends itself so positively to our
view of quarantine that it needs no argument in its fa-
vor, and the discharge of suspected vessels at the Up-
per Quarantine is excusable only by want of faeihties
at the Lower Bay, and at no time should more than
two or three vessels be discliarged at once, and at a suf-
ficient distance from either shore, to insure immunity.
Should stevedores or other employf-s sicken during the
process, the vessel is to be returned to the Lower Bay
and treated as an infected vessel.

Ship-heepcrs. — The employment of ship-keepers to
act as tests for the sanitary condition of the vessel may
appear questionable; but as they fully understand their
position, and are correspondingly paid, they voluntarilj^
assume the responsibility.

Sievedorinc/. — The stevedores are the most important
instruments in the hand of the Health Officer — his baro-
meters, bjr which he judges the sanitary condition of
the vessels ; yet as only suspected vessels are to be
discharged, or in equity can be discharged, the steve-
dores enjoy a certain security, although, of course, they
are exposed to constant danger. Under the regime of
Dr. Gunn they were mostly residents of Staten Island.
Roll was called every morning, and any absentee im-
mediatel}'' visited, and, if sick, taken to the hospital.
The vessel where he contracted the disease being, of
course, the one Avhere he labored five days — the univer-
sally accepted time of incubation in yellow-fever — pre-
vious to his illness, and such vessel then considered an in-
fected vessel. At present a barge anchored in the Ba}^
answers for their residence, and, of course, places them
still more under the vigilant eye of the Health Officer.

Lightering. — Under the present law, vessels in quar-
antine are lightered by persons and vessels licensed for
that purpose by the Health Officer, and though their
compensation is fixed by the Quarantine Commission-
ers, the exactions under this monopoly are such that
the lightering of cargo in quarantine is considered one
of the most oppressive burdens of commerce. And
when we consider that the vessels so licensed are daily
at the wharves of the city, and used at the option of
the owner for every other purpose, we must certainly
question the ecfuity of law which grants such monopo-
lies. It ia true that men on board are subject to infec-
tion by yellow-fever, but this can only happen if the
sanitary condition of a vessel has been improperly
judged ; and if it should happen, no one behoves at the
present day that a man sick with the yellow-fever could
communicate the disease to others in his residence.
The onl}^ thing necessary, then, and justifiable by reason
or experience, is that the men employed in quarantine
shall give bonds to the effect that any sickness occur-
ring among their employes shall immediately be re-
ported to the Health Officer.

IN VARIOLA.

An efficient quarantine is established by'prevcnting
the intercourse of the community with variola, and
the personal eliminations of the disease. Yariola did
not' exist on this continent before the advent of the
Caucasian race, and cannot originate de novo among
the nations which have supplanted the ' Aborigines.
It may, therefore, become absolutely extinct if we
succeed in cutting off all intercourse with the per-
sons diseased and their eliminations. The persons are
either the patients already manifesting the presence
of the disease in the particular eruption, or persons ex-

posed to the virus, in which the disease has not yet
made its appearance. The eliminations of the dis-
ease are its products — the scab in its progress to ma-
turity, and the more ethereal eliminations impregnating
j the clothing and other personal effects of the diseased
! within a certain distance. What this distance may
be, and the medium of its propagation, I am as unable
to determine as I am to explain how far the odor of
the patient may be cnrried, and by what means.

We find, perhaps, in this a vague but approximate
analogy. Certain it is that in no instance has the dis-
ease been known to have been communicated from
the Small-pox Hospital at Quarantine to the surround-
ing village, a distance of some 300 feet. An interest-
ing and rather amusing incident was related to me by
the captain of a Coohe vessel, on which small-pox ap-
peared soon after leaving port. He had a coop erected
in the mizzen-top, where he placed his two patients ;
not only did no new cases occur among the passengers,
but the convalescents descended hale and hearty after
spending three weeks there. Another captain quaran-
tined a case of small-pox occurring among his crew, by
placing him in a boat hung by a davit (rom the stern
of his vessel ; the man recovered, and no new cases
occurred.

Small-pox patients are now carried to the hospitals
on Ward's and Blackwell's Islands, and the only ques-
tion is the propriety of the mode of transportation in
boats used for other purposes? In the determina-
tion of the quarantine of well passengers, exposed to
the virus of small-pox, the extent and source of the
disease, as well as the mode of isolation of the sick,
must necessarily guide the Health-officer in granting
pratique. If occurring as an isolated case, only trace-
able to the port of clearance, vaccination of the pas-
sengers and immediate pratique is all that is desir-
able. When, however, a number of cases have occurred,
the port of clearance not being the source of infection,
but the sick on board of the vessel itself, thorough
vaccination, and revaccination of all that have not
taken the vaccination after four days' quarantine, are
indispensable ; and as vaccination only rec[uires three
days to manifest in its success entire and absolute
immunity from the disease, pratique may then be
granted, wiih the assurance that no new cases of
variola will develop themselves. If not thoroughly
vaccinated, new cases may occur, from seven to twenty-
one days after the first case, or thirteen days after
exposure and the maturity of the first case. For this
reason I would commend the mode instituted by our
lamented Dr. Gunn, who ordered the vaccination to
be done with fresh lymph, by Dr. J. P. Loines, of the
Eastern Dispensary, — almost invariably showing the
desired result on the fourth day. The superiority of
this plan over that of vaccinating from a scab, carried,
perhaps for weeks, in the pocket of a police officer,
appointed for the nurpose of vaccinating, can scarcely
be a matter of doubt in the profession. I would sug-
gest, as a sanitary measure, that all vaccination be done
by the vnccinating dispensary which may offer the
greatest facility of obtaining, at all times, sufficient
fresh lymph. In this way, not onl}- would it be done
thoroughly, but the Health Officer would be relieved
of the suspicion of giving orders merely for his own
pecuniary benefit.

The disinfection of clothing, bedding, or personal
effects, impregnated by the ehminations of small-pox
patients, may be effected by a continued high tempera-
ture, interment, or fumigation, or by over twenty-four
hours' exposure and ventilation on a warm summer's
day. Thirty minutes' exposure of the scab of the
small-pox patient, — the most concentrated form of

THE MEDICAL RECORD.

porsoiml eliniiiiatioiis — to a toinpernturo of 130" and
upwards, will di-slroy iLs virus as eflVctually iis three
days' liiirial in dry clay — a process cniciont f-nouf^li, not
only to render the virus perfectly inert, but also to
exterminate the pediouii so ofleii infecting the clothing
of small-jiox pa'ients. Simple washing and boiling
•will disinfect — but this measure may l)e carrii'd ad
ahsiinluin, if not oidy the effects of tlie patient, and
tlie materials within the reach of the elinnnalions of
the sick, but all the elTects of the passengers of a first-
class steamer are also required to be so treated. The
vessel itself recpiires no further quarantine than is
required to wash and clean the rooms occupied by the
sick, and by fumigation, entirely destroying the germ
of future infection. A scab from a patient exposed to
the fumes of nitrous a'id will oidy becDme inert after
continued exposure; while chlorine will only jiroducc
its etVect in its concentrated form. Fumigation in
small-pox is, therefore, to say the least, a questionable
expedient, and certainly much less reliable than high
temperature.

Having thus briefly spoken of the quarantine of
small-pox, and recommended the immediate removal
of the patient, vaccination of the well passengers,
washing or burying their personal effects, and the
cleansing of the vessel, let us proceed to the quarantine
of typhus.

The records of the quarantine hospital show that
cases of t^'phus were admitted during almost every
year, from its opening, in 1798, to the present day,
almost invariably occurring after long passages on
board of crowded vessels, with insufficient and
unwholesome food. But it was not until after the
Famine in Ireland, in 1847, that the disease really
became epidemic. From that year until 1853 over
twentv thousand cases were admitted and treated in
the Marine Hospital, crowding the buildings to over-
flowing, and necessitating the temporary occupation of
the public stores for hospital purposes. These were
four stories high, large and massively built, with ceil-
ings not more than nine feet high. The mortality in
these was, however, so fearful that they had to be
abandoned, and temporary shanties erected, thereby
diminishing the percentage of deaths to nearly one-
half Since 1853 the number of cases has been steadily
decreasing, until in the last few years comparatively
few well-authenticated cases have occurred eitlier on
ship-board or in the Emigrant Hospital. "With increased
facilities of intercourse and commerce, of railroads and
steamboats, famine has become well-nigh an impossi-
bility, and typhus, the legitimate offspring of inade-
quate nourishment and bad ventilation, has ceased its
ravages in Ireland, its principal habitat. With the
advent of ocean steamers and quick passages, it is
scarcely possible that we shall evearhave any consider-
able number of typhus patients to provide lor, or that
there will be occasion for quarantine regulations to
prevent its introduction. Typhus can originate as an
epidemic only from ^rand national disasters, and, as
already mentioned, it follows in the wake of famine
and destitution, and is communicable, contagious, and
infectious only by personal eliminations of the sick
poisoning the immediate atmosphere, and rendering all
within its precinct amenable to infection. The more
concentrated the poison, by reason of the great number
of the sick, and the less the number of cubic feet of
air allowed to each sick individual, the more intense
the poison, and the greater the danger — hence the
terrible mortality in the public stores^ already men-
tioned, where not merely fifty per cent, of its inmates,

but also of the nurses and attendants who entered
them, were among the victims. To the same cause
may also be atiibuted the virulence of the disease on
board of emigrant vcs'sels crowded with pa.ssengers,
imperfectly fed, and witli less than the re(iui.site amount
of air to sustain a healthy condition. l3r. Doanc, the
lamented Health Officer, died after a single visit to
the steerage of one of these ve.s.sels. As heated air
ascends, so will the air impregnated with the virus of
typhus ascend — in proof of which I may give my
experience in one of tlie typhus wards, in which almost
every patient in certain beds of the ward died, while
others recovered. Upon examination it was found
that a shaft communicating with the ward below
opened directly under these beds. For the same rea-
son we find that on board of emigrant vessels the disease
is much more prevalent in the neighborhood of air-
passages, communicating with the lower deck containing
ca«es of this disea.se, than elsewhere. And while the
morbific cause of the disease is so potent in the wards,
it is a singular fact (hat a few feet beyond it, and
by the interposition of a comparative narrow stratum
of pure air, all danger ceases. There is not a single
instance on record in which the disease was communi-
cated to a distance greater than one hundred feet from
the typhus ward, where every attendant sickened and
many died.

The quarantine of typhus, therefore, is simply isolation
of the infected ; and the present provision at Ward's
Island is probably as good as can be provided, as no
possible danger could accrue to the city in their tran.s-
portation, or to the other sick of the hospital, if any
number of typhus patients should be provided for in
isolated buildings on the island. Not oidy those sick
of typhus, but all who have been exposed to, and there-
fore subjl'ct to the disease within the ordinarily accepted
period of incubation, should immediately be removed;
and I know of no place better adapted for the reception
of sucli passengers than the extensive fields of Ward's
Island, where, during the winter season, they can be
placed in well ventilated houses; but in summer, if
possible, they should live in tents. An instance of a
quarantine of this kind we had a few years since in
Perth Aniboy, where the passengers of a badly infected
vessel were disembarked, quarantined in open tents,
and not a single case occurred after their disembaika-
tion. Indeed, I hold the practice of retaining the pas-
sengers on board of vessels on which typhus had pre-
vailed as most reprehensible ; for although the sick
may be removed, and every precaution taken to pre-
vent the further progress of the disease, it cannot thus
be arrested. In the instance of the Ctpiosure we have
the most painful illustration of this. Not only did fur-
ther cases occur after debarkation at Quarantine, but
I valuable lives were lost, and the entire depot at Castle
: Garden was endangered by this nefarious practice.
The quarantine of vessels after the debarkation of the
1 sick and well is only requisite for the time necessary
I to thoroughly cleanse and fumigate them ; and here the
\ fumigation by chlorine gas, generated from a mixture of
j the black oxide of manganese, salt, sulphuric acid, and
water, is certainly the most efficacious. Merchandise
. from vessels with typhus on board can never be the
subject of quarantine ; for there is no instance on record
in wliich it was, or could possibly have been, the mor-
bific agent of the disease.

CHOLERA.

The literature of cholera is so voluminous, and the
history of its Indian origin and prevalence, its migra-
tion over the Continent of Europe before it reached
America in 1832, is so familiar to all that I cannot pre-

THE MEDICAL RECORD.

sume to refer to it except in its relation to the subject
before us — the quarantine of cholera.

The verdict of the ablest wiiter is, " that all quarantine
and sanitary cordons are useless." I admit at once the
truth and equity of the verdict, unless all intercourse
■with the locality whore the disease prevails as an epi-
demic, even in a limited form, is absolutely and entirely
out off; for the researches of Pettenkofer, corroborated
by our own experience, prove beyond a question, that
though persons from an infected locality are invariably
the pioneers of the disease, vi'hcrever it occurs, they
may be apparently in p;ood health when they leave the
source of infection, and unconsciously to themselves,
or inappreciably to others, be the carriers of the
disease. But while admitting this as truth in Europe,
and on this continent if the disease has once taken a
foothold, 1 make the assertion with as much assurance,
that with a sanitary cordon of 2,000 miles in width, and
a lapse necessary for its transit of ten daj'S or even
move, an efficient quarantine ma}' prohibit and absolutely
prevent the introduction of the disease into America.

Before 1832 the records of quarantine exhibit, almost
annually, deaths from " cholera morbus ; " but not until
the lOtii of July of the year named have we any rec-
ords of Asiatic cholera at the quarantine hospital.
The disease had then already become epidemic in
Quebec and Montreal. Whether it had been conveyed
to this port by the Henry IV. from Havre, or whether
it had been brought hither by the ship Carrick from
Europe, arriving on the 1st of June, only a few weeks
prior to the Henry IV., I will not undertake absolutely
to decide. It is rather ominous that the first two cases
Avere admitted from New York, and not from ship-board.

A brig bound from New York to New Orleans was
wrecked on Folly Island, and the passengers and crew,
among whom cholera had prevailed previous to the
disaster, were taken ashoi-e. The disease extended to
the feAV negroes and wreckers living there ; physicians
and nurses were sent from Charleston to attend the sick.

In January, 1833, a man-of-war arrived at Havana
with cholera on board. In February it became epi-
demic in the town, carrying off" over 10,000 persons, or
10 per cent, of all its inhabitants.

In 18-iS cholera prevailed in Bremen. Unal^le to
procure the desired accommodation, a number of emi-
grants went to Havre, and thence took passage on the
New York sailing on the 9th of November. On
the loth cholera first appeared among the passengers
from Bremen. On her arrival here in New York, on
December 6th, seven had died and eleven were landed
sick. The remainder were landed at the public stores.
Many were subsequently taken sick, and the disease
extended to the hospitals and the surrounding build-
ings — the first case occurring on the 6th of December
in the building nearest to the ward where the female
cholera patients from the Neio York had been placed ;
and on the 8th of December another, in the ward con-
tiguous to the cholera hospital for males; on the 10th
of December several cases occurred in the building
where patients from the same ship with other diseases
had been placed. In all, over 100 were attacked.

In the spring of 1819 a number of vessels arrived
with cholera on board, the disease again extending to
other patients, over 100 dying. But it was not until
May that it made its appearance in New York.

In Boston the Argyle arrived from Scotland, with
cholera on board, on the 4th of June. 600 deaths
occurred from the 11th of June to the 13th October. In
New Orleans the first case of cholera came from the
ship Swinton, arriving on the 2d of December from
Havre ; and from the 11th of December until the 7th of
February ov^er 1,200 died.

The fatal consequences that have almost invariably
followed the new introduction of cholera during the sub-
sequent years, have not been so appalling as the above
mentioned. But the books of the Marine Hospital
prove that, in almost every instance when cholera was
brought here from ship-board, the disease spread among
the sick inmates nearest to the wards containing the
patients, and more than once decimated the hospital
in its fearful progress.

In 1858 the quarantine hospitals on Staten Island
were destroyed by a mob, and the port of New York
remained exempt from a visitation of cholera until
1866, when the Atalanta arrived from Havre, reporting
60 cases and 15 deaths from cholera during the passage,
and having 21 sick with cholera on board. These, and
23 other cases which occurred while the vessel and
passengers were at quarantine, were sent to the Float-
ing Hospital. Thirty days subsequent to her arrival,
and ten days after the occurrence of the last case, the
vessel received pratique, and no further cases were
reported either among the passengers discharged or the
employes of the hospital. About the same time cases
of cholera occurred on vessels arriving from the same
ports; but the disease again disappeared before they
reached New York. It is, however, remarkable that
the disease, on these vessels at least, could be traced
to the same hotel in Havre ; all parties corroborating the
statement that several persons died of cholera while
the passengers who became the first victims on the
different vessels boarded there.

If, then, as cleaily proved by the facts before us, cho-
lera never appeared here except when brought from
abroad ; and persons were invariably the carriers of the
disease, both to the vessel and from the vessel to the
shore, the quarantine of cholera is a quarantine of per-
sona, and the virus, reproducing the disease, is the
personal elimination of the cholera patient, but differ-
ing from the virus of small-pox and typhus — both
eruptive diseases — in not being the eliminations of the
skin but of the alimentary canal.

The "Floating Hospital" used on the emergency of
the arrival of the Atalanta' s passengers was, for the
purpose, certainly preferable to the hospital on Staten
Island ; for not only was their isolation more perfect,
and the danger of communication to convalescents or
sick of other diseases, especially typhoid, avoided, but
the dejections of the cholera patients, incontrovcrtibly
the principal receptacle of the morbific agent, and the
generative principle of the disease, were cast into the
sea, and with them all danger of infection and commu-
nication was avoided. The buildings on West Bank,
lately erected, may offer greater facilities and comforts,
but scarcely as much security. The well passengers of
cholera-infected vessels may be divided into two clas-
ses : the first, where the disease already exists, but the
patient suffers merely from a colliquative diarrhea,
scarcely more than a matter of incouvenience to him,
but equally morbific in its agency as the dejections of
a cholera patient in a state of collapse ; the .second
class, merely the subject of the incubation of the dis-
ease, but in whom no development has as yet taken
place, comprising, of course, all the pa=sengers exposed
to the morbific agency of the disease. For this class, the
buildings on West Bank are most admirably adapted.
The time of quarantine may be fixed at 10 days after
the occurrence of the last ca^e, being three days longer
than the accepted period of incubation. Though this
may seem long, we must not forget that a single case
may be the cause of an epidemic, as clearly proved by
Pettenkofer, in the history of cholera at Altrau, in
1865, when the disease Avas introduged by a lady direct
and only five days from Odessa; in Thoyden Bois, in

THE MEDICAL RECORD.

Enpland, bv a pcntleman from London, and in our hos-
pitals, by the arrival of a single cholera patient from
Aspinwall,

The cpiarantinc of merchandise may be safely re-
duced to the quarantine of merchandise soiled by the
<h'je>tion» of cholera patients, and to personal effect*.
Dr. Simpson relates a cai;e of the transmission of the
disease by a chest of duthinfj fri)m a cholera patient,
aideil perliaps b}' the use of unwhulesomo food con-
tained in till) same chest. That the disease in the
Marine Hospital almost invariably attacked others in
t!ie same buildinp or in the adjacent ones, may be ex-
plained by the fact that tlie soiled linen of cholera pa-
tients was placed in a building attached to the water-
closet, and allowed to remain there for days, these
being only a few feet distant from the shanties used for
the reception and treatment of the cholera patients.

The disinfection of the clotliin2; and rags, the only
merchandise which properly can be so|led by the de-
jections, can be eOTected by ventilation, fumigation, and
submerging in a sohuion of the sulphate of zinc, or,
better still, of carbolic acid. How long sucli effects
may retain the cholera virus is rather a matter of
opinion than of positive demonstration, and if effects
infected with tlie cholera virus may be disinfected by
exposure and ventilation, and if cholera effects dis-
infect;Hl in this way may c;iminat3 the morbific virus,
through our own medium, the air. the most pertinent
questiou is the distance to which such morbific agent
may be carried. In answer I may cite the theory of
Mr. Simon, that the cholera germ diminishes in ratio to
the square of t'.ie distance from the point of emission.
Certamly no case has come under my observation,
where the gerui was carried more than 200 feet, and
the hospital on West Bank oilers, therefore, t!ie desired
seen ri ty.

The quarantine of vessels, after the discharge of the
passengers, and thorough fumigation and washing by a
solution of carbolic acid, is scarcely necessary beyond
the time required to do this; and the first instance has
yet to be adduced where the infection could be traced
to vessel or cargo.

In speaking of the quarantine regrulations, I have
treated the subject as my long experience and famili-
arity with the practical workings of quarantine de-
mand; and in presuming tj make suggestions before
the Academy of Medicine, I invite their delibera-
tions to questions which can only be decided by men
of science, and thoroughly familiar with the mode of
propagation of each disease. The community looks to
the profession as its legitimate guardians, and the mer-
chant for relief from exactions and impositions.

VACCINATION DURING THE FEVER
STAGE OF VARIOLA.

By J. H. TYNDALE, M.D.,

HOUSE SUBGEON, GERMAN HOSPITAI., N. Y.

Previous to the great discovery of Sir Edward Jenner,
towards the close of the eighteenth century, the rate
of mortality from small-pox was enormous, and is
estimated to have reached fifty per cent. Moreover, the
symptoms and course of the' disease were of a more
aggravated character. No wonder then that efforts had
been made from the earliest periods to mitigate the out-
breaks of the epidemic by preventive measures, as well
as by the administration of remedies.

When and where inoculation originated is not known.
From time immemorial the Chinese have practised a
method of" sowing'or disseminating '" the disease, which

consists in introducing the scales of the eruption into
the nostrils. At a very remote period, in Hindostan,
a tribe of Brahmins resorted to it as a religious ceremo-
ny. A small incision was made, and cotton soaked in
the virus applied to the wound. Oflerings were devot-
ed to the goddess of spols to invoke her aid ; this divi-
nity having first hinted at inoculation — " the thought
being much above the reach of human wisdom and fore-
j sight." But the merit of introducing the practice into
England, from Turkey, is due to Lady Mary Woriley
Montague. Writing from Adrianople, in April, 1717,
she observed: "Every year thousands undergo this
operation ; and the French Ambassador says pleasantly
that they take the small-pox here by way of diversion,
as they lake the waters in other countries. There is
no exam|de of any one that has died in it; and you
may believe I am very well satisfied of the safety of
the experiment, since 1 intend to try it on my dear lit-
tle son. I am patriot enough to take pains to bring
this useful invention into fa.shion in England." (The Let-
ters and Wurks of Lady Mary Wortley Montague, third
edition, vol. i., p. .'509. London, 18G1.)

The debt which our ancestors owed to this lady
is not diminished by the fact that inoculation had been
practised for very many years in South Wales, where
it was known as " buying the small-pox ; " for this cir-
cumstance only became generally recognized as Lady
Montague's views engaged attention, and while she
enjoyed the privilege of being the best-abused person in
England."

It has been calculated by the Ragistrar-General of
England, that the average number of deaths aimually
occurring from small-pox in London, during the years
1660-79, were 357 to every 100,000 inhabitants, where-
as in 1859 they were A'l only lor the same proportion.
Later statistics have reduced this proportion still further.

But even the most palpable evidences of the bene-
fits of vaccination have never sufficed to quell the oppo-
sition to it. Statistics have been published, laws passed
and enforced, and still the voice of opposition is as far
from being stifled as it was nearly one hundred years
ago. It is even at present so vehement that intelli-
gent physicians have entered their protest against vac-
cination as utterly inefTective. The press has also to
some extent endeavored to establish the futility of the
enforcement of the measure. To defeat this broad asser-
tion nothing is needed but a reference to the statistics
of au}' country, since the introduction of vaccination.

Some of the objections urged seem at first glance to
be quite reasonable; but on closer scrutiny it will be
found that all are based upon false presumption?, and
consequently woithless.

It has been argued: 1st. That the prevention was
wor.se than the disease; the dissemination of the poison
throughout the body was paramount to an introduction
of the disease itself, the consequences whereof could not
be calculated. While it is true that the poison is intend-
ed to be and is disseminated throughout the sj^stem, it
must be remembered that the constitutional disturbance;
caused by the introduction of the virus is of the mildest
character, and never productive of evil results. On the
other hand, the benefits derived from it are immunity
from the disease for a period of from seven to ten years,
and certain immunity at the time of an epidemic, as
my experiments, to be spoken of hereafter, will conclu-
sively prove.

A second objection is the possibility of engrafting
upon the constitution such diseases as syphilis, scrofula,
etc., by means of virus taken from persons afflicted with
these diseases. There can be no doubt that by the use
of a foul lancet pyaemia has been caused, and abundant
evidence exists of the fact of syphihs having been com-

THE MEDICAL RECORD.

muiiicated by vaccination. The use of a dirty lancet
can, of course, and ought to be avoided. As to the in-
troduction of syphihs and other blood contaminations,
Dr. Viennois, in an exhaustive paper upon the subject
(Archives Generales de MCdecine, vol. i., p. G41 ; vol. ii.,
pp. 32, 297 ; Paris, ISGO), has come to the conclusion that
if" the lympli from a vaccine vesicle alone be introduced,
the cow-pox alone will be introduced; but if in addi-
tion the blood of a person afilicted with syphilis be
also inoculated, then sypliilis will likewise be commu-
nicated. At the present period, lymph from the vesicle
is almost universally employed, a fact to which I will
refer again hereafter.

Tlie third, and perhaps most plausible objection, is
the uncertainty of a fixed period of immunity. The
term of immunity is variously estimated at from seven
to ten years, after which time the protection is sup-
posed to have lost its power. Prof. Felix von Niemey-
er, lately deceased, had instituted inquiry in that di-
rection, and promised a treatise upon the subject at
some future day. The work may have appeared lately,
but has not come under my observation. Niemeyer
feelsjustified in concluding in advance that vaccination is
at all times necessary during an epidemic. Now in a city
like New York, and all large places, small-pox never
entirely disappears, and an epidemic is only spoken of
when the cases are multiplied beyond the ordinary
number. It is at such times that our health authori-
ties, ever watchful of the welfare of their fellow-citi-
zens, issue orders for the disinfection of affected neigh-
borhoods, and urge the people to permit themselves to
be vaccinated. Perhaps compulsion would be a better
course. And then it is that the question arises, not only
whether previous vaccinations will procure immunity,
but whether the same now performed is to be consid-
ered a perfect safeguard during the present epidemic.
There is often doubt in the minds of persons, coming in
contact with the small-pox, who have subsequently
been successfully vaccinated, whether they would not
have escaped the disease without being vaccinated.
This is in a great measure encouraged by the assertions
of those who have been, or imagined themselves to have
been, in contact with it, and providentially escaped in-
fection either without previous or present vaccination.
The escape is generally credited to an abundance of
moral courage. This induced me to ascertain whether,
after a positively decided contagion has taken place,
and, the period of incubation being passed, the fever
sets in, it would then be of any avail to vaccinate.
And the results more than fulfilled my expectations.
An epidemic of small-pox, which broke out in the city
of St. Louis, and continued for three or four months,
furnished the necessary material. While I was acting
in the capacity of public vaccinator, a young man pre-
sented himself for admis.sion into the hospital, suffering
from all the preliminary symptoms of variola. He stated
that he had been nursing his brother, then lying sick
Avith small-pox, for the past twelve days, relying for
protection against the disease upon vaccination perform-
ed in his childhood. For the past forty-eight hours he
had high fever, with intense frontal headache, well-
marked pain in the back, swollen tonsils, and, in short,
every premonitory symptom of variola. I vaccinated
him carefully, and sent him to tlie hospital to await the
result.

On the following day (expectant treatment having
been followed) the fever, headache, and pain in the
back had abated. An elevation at the point of vacci-
nation and a slight redness indicated the success of the
inoculation. The patient fth perfectly comfortable. The
vesicle gradually dried up and ft^ll off about the eight-
eenth day. No further symptoms were experienced by

the patient. In order to fully satisfy myself of the
truth of my patient's statement, I called on his brother
and f jund him in a convalescent stage of variola, the
pustules having mostly broken and formed scabs.

The success of this case encouraged me to put my
h3'potliesis to a still further lest. During the course of
the epidemic, eight other cases of the same nature pre-
sented themselves, the details of which are not necessary
to describe. Suflice it to say that in each and every
case the contagion was fully established. The result in
each case was precisely the same as in the first case
related above. In two cases the fever stage had lasted
fully two days, as in the first case. In the others the
fever had continued from twelve to thirty-six hours.

In one case only, the result was unfavorable. The
fever in this instance had continued for nearly three
days, when the inoculation was performed. A few
hours later the eruption made its appearance all over
the body, and the case proved a discrete one. I can
scared)' assume that vaccination exercised any modify-
ing influence, f ince no vesicle was reported to have made
its appearance (the patient being under the care of
another physician), yet the possibihty of such an event
cannot be denied.

As regards the modus operandi of the virus at this
stage, I cannot look upon it as different from that of an
ordinary vaccination. A good absorbing surface being
produced, and the virus introduced in a state fViVorable
to absorption, it is readily carried into the circulation.
Ca[)illary circulation being very active during the fever
stage, as evidenced by the thermometer, seems to me to
favor the absorption of the virus. This may in some
measure account for the unusually rapid appearance of
the vesicle. It is not my intention to speculate with
regard to the action of the virus in the system. Whe-
ther it acts as a ferment, or, in some manner unknown,
attracts the poison within the system to that particular
spot, are mere matters of speculation. It is a well-
known fact that counter-irritation, as for instance the
application of croton oil to some particular part of the
body, as the chest, has the effect of determining the
eruption to that neighborhood.

If we choose to consider a local point of irritation a
favorable spot for the eruption, the question will be
solved as fur as speculation can solve it. The fact that
at that point the skin has been removed and the corium
exposed, will render the spot a "locus rainoris resis-
tentise" for the eruption.

I think that the results of these experiments will
justify me in calling the attention of tlie profession to
them. My excuse for presenting so limited a number
of cases, lies in my inability to put it to a further test,
owing to want of material. Nevertheless, I do not
hesitate to affirm that vaccination, properly j)erformed,
previous to the exacerbation of tltejfever on tlie third day,
will cut short the disease, hy quickly relieving the general
symptoms of small-pox, and causing a icell-marked erup-
tion on the spot inoculated.

It must be borne in mind that the fever accompany-
ing variola is of a remittent type, and, like all remittent
fevers, has its highest range of temperature in the even-
ing. The third, and usually the last exacerbation, is
also the most severe (marking the highest temperature),
and quickly followed or rather accompanied by the
eruption. Vaccine virus introduced during this last
remission will scarcely have time to be absorbed, though
it is possible that when absorbed it may mitigate the
character of the eruption. Of this, however, no positive
proof exists, and it is merely mentioned as a possibihty,
if not a probability.

In inviting the attention of my colleagues to this
important matter, I cannot refrain from requesting a

THE MEDICAL RECORD.

strict observation of llie ordinary cautions in further
testiiip the results of vaccination during tlio fever stnpc
of variijla. That the virus sliould be pure, unmixed
with Mood, and not too old, need scarcely be mentioned.
For my part I have loimd tiie recently dried scab, ex-
clusive ol the inllammatory products on the perii)hory,
rubbed up carefully with a drop of water or glycerine
to a creamy consistence, to answer the purpose admira-
bly. Various ages and various physicians have had
their own peculiar method of introducing the virus,
either by punctures of the skin or liy scraping away
the cuticle. Punctures of the skin, whether performed
by the lancet, a pin. or some instrument invented fi)r
the purpose, are open to two objections. In the fust
place, tlie [»uncture will close immediately upon the with-
drawal of the instrument. Even when the virus is
introduced with the pvmcturing instrument, the appli-
cation is too .sudden to insure absorption. In the second
place, it often occurs that, notwithstanding proper care
is taken, blood will follow the puncture. Extravasated
blood is verv slowly reab-orbod, and tlicrefore a hin-
drance to absorption of the virus when the latter be-
comes mixed with it.

In my opinion, scraping of the cuticle with a dull
lancet until the coriuin is exposed, i.s, although a more
laborious, afar more certain method. The first appear-
ance of moisture on the scraped spot is an indication of
having reached the proper absorbing surface. It is well
not to be too sparing in the application of the virus, but
to spread it upon the absorbing surfaces (for there
should be two) as thickly as possible.

A CASE OF RECOVERY FROM DIPHTHE-
RIA AFTER THE OPERATION OF
TRACHEOTOMY.

Reportkd by GURDON BUCK, M.D.,

NEW TOBK.

Visited Ricliard, son of James H., pot. 10, residing
No. 8 Dover st., at four o'clock p.m., Nov. 28, 1871, by
request of Dr. C, his attending physician, and found him
suffering from very urgent and increasing dyspnoea;
his voice was reduced to a whisper ; cough was croupy ;
pulse frequent but regular; surface perspiring freely
from the labor of respiration. He had been frequently
vomited by medicine the preceding night, but without
relief; croupy symptoms had existed tor two or three
days, and had become urgent within twenty -four hours.
It was reported by his father that his physician had not
found any exudation in the fauces. For some reason
not explained, the attending physician did not appear
at the hour appointed. After waiting a reasonable time
I decided, in view of the extreme urgency of the symp-
toms, to proceed to operate. Fortunately the attend-
ance of Dr. A. J. Harrison, who had visited the patient
once, was R?cured without much delay. A narrow table,
covered with suitable bedding, answered the purpose of
an operating table. Four sperm candles cut into halves,
and bound with tape into two bundles, served as lights
that could be conveniently held at any point where
they were required. No anaesthetic was administered.
The boy's father held his head, and kepthis neck on the
streteh, while his godmother held the torchlights. The
embarrassment of having only one medical assistant for
the operation was felt at every step. The only feature
of the operation to which the author would call atten-
tion is the expedient employed to facilitate the opening
into the trachea itself. Two accidents are liable to
occur in this step of the operation. One is, the incision
may deviate from lh3 median hne; the other, failing

to penetrate into the interior of the trachea, the knife
may pass either between the outer surface of the tra-
chea and it.s coverings, or between its inner j-urface and
lining membrane. The procedure was as follows: An
ordinary pocket-ease tenaculum was thrust between the
cricoid e.utilage and first tracheal ring, exa<"tly in the
median line, .-ind made to hook up the cricoid, thus
Serving to maintain a .'^ecure hold upon the trachea, and
keep it at rest. While the tenaculum was held witli
the left hand, a sharp-pointed knife, held in the right,
was made to |)enetrate the trachea immediately below
the entrance of the tenaculum, and an incision was car-
ried downward through the four upper tracheal rings.
The knife, without being withdrawn, was immediately
carried back to the point of entrance, and a tran-sverse
cut two lines in length was made on either side between
the cricoid cartilage and first tracheal ring, giving the
tracheal opening the shape of a letter T. A double tra-
chea tube, previously armed with a piece from the
blunt end of a gum-elastic catheter traversing it, and
with its l)lunt point projecting a little bev'^ond llie inner
end of the tube to serve as an obturator, was then
inserted and secured with tapes passed around the
neck. After the disturbance, always consequent upon
the first introduction of a tube, had subsided, the res-
piration became tranquil and the patient soon fell into
a placid sleep. Instructions were given for the re-
moval and replacing of the inner tube as often as it
required cleansing. About three hours after the opera-
tion the tube became obstructed by a coagulum, and
the parents not succeeding in removing the inner tube,
suffocation would have taken place had not Dr. Harri-
son fortunately reached him in time to dislodge the
inner tube, which he did by prying it out with a knife-
blade.

During the subsequent forty-eight hours the respira-
tion continued easy, and his general condition satisfac-
tory. At my visit in the afternoon of Nov. 30, how-
ever, I found his respiration hurried and labored, and
it had been so for two hours. The tube had been kept
clean and free of obstruction. The outer tube was now
removed for the first time to cleanse it and change the
fastenings. This permitted a view of the wound, the
surface of which was found coated with a layer of gray-
ish tenacious exudation, not, however, pellicular. From
this appearance the diphtheritic nature of the disea-e
was obvious, and it was inferred that a similar exuda-
tion was obstructing the air-passages and producing the
dyspncea from which the patient was siiftering. After
replacing the outer tube, and .supporting (he patient in
a semi-sitting posture, a solution of common table salt,
in the proportion of one teaspoonful to a teacupful of
warm water, was poured into the trachea through the
tube, one teaspoonful at a time, and at intervals which
allowed the immediate disturbing effect of it to subside.
A violent cough was immediately provoked by the en-
trance of the fluid, accompanied by the expulsion of a
quantity of the viscid secretion in a diluted state. Five
or six teaspoonfuls were thus introduced in succession,
when he became somewhat exhausted by his efforts in
coughing. While supported in a half-sitting posture
his breathing soon became easy and unobstructed, and
continued so without any subsequent recurrence of
dyspnoea. He continued to cough more or less, but a
good night's sleep followed. The next day he was
found doing well ; his pulse reduced to 100 ; his surface
natural ; his countenance animated, and his spirits cheer-
ful. Inspected the fauces, and found no diphtheritic
exudation in sight. He craved solid food and enjoyed it.

Ordered R. Sulph. quinine, sulph. ferri, 32 3 ss. ; acid
sulph. aromatic. Ij.; syrup zingib. | vij. ; aquae cinnam.
5 ij. Dose, 3 j. ter in die.

THE MEDICAL RECORD.

Dec. 2. Doing well. Removed and replaced the tube,
and found the surface of the wound clean and liealthy ;
appetite good.

Dec. 3. An urgent message summoned me to visit
him at iialf-past five o'cloc-k p.m. A hemorrhage from
the wound, represented as very considerable, had taken
place and alarmed the parents. His pale countenance
and feeble pulse (SO per minute) showed the ellect of
the loss of blood. A thorough examination of the
wound, the surface of which was pale, could detect no
vessel. Tlie occurrence of the hemorrhage Avas the
more remarkable as. at the operation, the bleeding had
not been considerable, and no vessels had required to be
ligated.

Dec. 4:. No recurrence of hemorrhage; doing well;
respiration natural and easy ; appetite good.

I)ec.. 7. Progress favorable. With the tube left out
and the external wound closed by the fingers, patient
could articulate some words in a natural tone of voice.
I therefore substituted a fenestrated single tube for the
double one, and closed the outer end with a cork, thus
allowing him to use his voice and to breathe through
the larynx, which he did without eflbit.

Dec. 9. Patient passed the day without a tube. The
lateral edges of the wound have come into contact with
each other, so that the air no longer escapes through
the wound; respiration is now pei'foi'med per vias na-
turales. His voice has still further improved. His
cough continuing troublesome at night, the following
mixture is prescribed: —

1^. Ext. senekse fluid. ) -. , ..
Tinct opii camph. ( ^' -* J-
Spirit nitri dulc, 3 ss.
Syrup balsam tolut., 3 ij.
M. Dose, "j. pro re nata.

The follow-ing preparation in the form of spray was
freely used throughout the whole treatment alternately
Avith hme water, and apparently with good efiect : —

5. Ammon. muriat. } -- _ ••

Potas. chlorat. f '^'^ ^ ^^■

Tinct. seneka3, 3 j.

Aquic ros8e, 5 iv.
M.

Jan. 11, 1872. Patient was visited, and found in all
respects well. His voice had regained its full force.

OVARIOTOMY.

TREATI.VG THE PEDICLE WITHOUT CLAMP. LIGATURE, OR
CAUTERY.

Being a Taper read at the Meeting of tlie Medical Society of the State
of New York, held Feb. 7, 1872.

By JULIUS R MINER, M.D.,

* BUFFALO, N. Y.

Gentlemen — During the past few years I have been
led to make some observations as to the anatomical
characters of ovarian disease, and to base upon those
observations, and a few clinical facts which have come
to my notice, the conviction that ovarian tumors —
cystic disease of the ovary — can be removed by e/iuclea-
tion, without ligature, clamp, or cautery. All other
steps in ovariotomy have been pretty Avell settled;
this one alone, of hoAV to treat the pedicle remaining
subject to the caprice of the operator, directed by no
well-defined rule or law. Without attempting to enu-
merate the objections which may be fairly urged
against all previous plans of procedure, allow me to
describe a neio method, which, I am now led to believe.

will in all, or nearly all, cases be found feasible, and if
so, is in every respect satisfactory.

My first observation and experience in this procedure
occurred in April, 1809, and the case was reported in
detail in the Jit(ffalo Medical and Sunjirul Journal for
June of the same year. It was described as follows : —
" A few months since I was invited to remove an im-
mense ovarian tumor, occurring in the person of Mrs.
Foster, of Cattaraugus County, N. Y. It was of a year's
standing, had been repeatedly tapped, but at length
the contents proved to be too thick to be drawn
through the largest-size eanula; and the distress becom-
ing too great for endurance, any operation which
would end it, whatever might be the result, was gladly
accepted. The tumor was inultilocular, very large,
weighing, as near as could be determined, nearly one
hundred pounds. It was attached throughout its en-
tire circumference to the omentum, intestines, walls of
the abdomen, and all other parts with which it came
in contact. These attachments were not so firm but
that they could be broken up, and with great care the
tumor was separated from the surounding parts until
the pedicle was reached. The process of enucleation
had been carried on so successfully and so extensively
that encouragement was afforded for continued trial :
the pedicle was large, and extended over a wide surface,
but by careful and patient effort it was separated fiom
its entire attachment to the tumor, and tlje immense
growth removed without (he ligation of a single vessel.
The terminal branches of the vessels of the pedicle
gave out no more blood than issued from the vessels of
the attachment elsewhere, and there appeared no more
occasion for ligature here than elsewhere. All hemor-
rhage soon ceased, and the incision was closed by inter-
rupted suture."

The success of this procedure was complete, and the
patient continued for more than two weeks to improve
without an untoward symptom — so long that her re-
covery seemed certain. She now commenced to lose
her relish for food, grew weak and desponding, and
died fiom exhaustion on the twenty-first day afier the
operation. The fatal termination detracted nothing
from the success of this mode of treating the pedicle ;
indeed, so remarkable Avas the size and attachment of
the tumor, tliat any attempt at recovery is surprising,
and yet the feeble, emaciated, exhausted patient con-
tinued to live long enough to show tliat the manner of
treating the pedicle was, at least in her case, unobjec-
tionable.

My second opportunity to test the feasibility and
safety of the plan I liad suggested presented itself in
the Buffalo Greneral Hospital, in December of the same
year, in a German woman sixty-six years old, of feeble
and delicate appearance, and considerable emaciation.
The operation was made iu presence of the students of
the Buffalo Medical College, and I was assisted by my
colleagues both of the College faculty and hospital staff.

This tumor was found also extensively attached to
the walls of the abdomen, and the process of separation
Avas conducted as before, the bands of attachment being
separated from the fibrous cj'st of the tumor, not torn
or broken. On reaching the pedicle it was found
large, its principal arteries throbbing distinctly. It
Avas separated readily by enucleation, commencing at
its central attachment, and folloAving out the fasciculi
of vessels to their final termination upon the Avails of
the tumor. Upon removal, it was found to Aveigh
seventy-one pounds, and to be composed of numerous
cysts. The bands of vessels composing the pedicle,
when separated from the tumor, contracted so as to
leave the pedicle appearing almost as if it had been
divided Avith the knife. To the sui-prise of my asso-

THE MEDICAL RECORD.

ciate-i, scarcely any homorrhnjre followed the separa-
tion, much los^ than attended the separation of tlic
bands of attachment cNewhere. This i)niient was nar-
cotized hy ?nbcutaneous injection of morpliine given by
my Hospital Assistant. She died eighteen hours after
the operation. Post-mortem examination .showed no
hemorrliage or other explanation, and we inferred that
death was from overdose of n)orpliii)e.

My friend and eclle.ngue Prof James P. Wiiite, of
Buffalo, has since made succes-fid trial of tliis plan of
operation — that is, successful sd far as removal by enn-
cleation witliont hemorrhage is concerned. He in-
forms me that there was less hemorrhage fron) the
pedicle than from otlier places of attachment; and that,
though he finally applied ligature, he did not do it
from nece.«.sity, but rather from fear of its occurrence
after reaction should take place. Other similar cases
might be related, but I prefer to refer brictly to the
experience of others, in confirmation of my own obser-
vations. Richard H. Meade, Esq., Consulting Surgeon
to the Bradford Infirmary, England, thus speaks upon
the subject: —

"The patient being under the influence of chloro-
form, I made an incision about four inches long in the
lower part of the linea alba, carefully opened tlie peri-
tonreum, and evacuated nearly two gallons of ascitic
fluid. On enlarging the opening in the peritonteum to
the same extent as the external wound, the ovarian
tumor at once came into view. I now' directed an
assistant to compress the abdominal walls with his
hands, one placed on each side, so as to compress the
edges of the wound backwards, while I endeavored
Avith my hands to draw the tumor partially through
the opening. In doing tliis, the walls of several of
the small cysts, of which the tumor was principally
composed (being very thin), were ruptured by the
pressure of my fingers, and a considerable quantity of
thick, brown fluid, like dark-colored linseed tea,
escaped. The edges of the Avound were so well
compressed that none of this ovarian fluid was allowed
to enter the peritoneal cavity. The tumor was now
found to be firmly adherent to the free extremity of
the great omentum ; these adhesions Avere carefully
and slowly torn through, and the whole mass was
then easily drawn through the wound. It was now
found to contain a good deal of heav}', solid matter,
and, on turning it over to examine its attachments,
the pedicle, which was small and thin, to my dismay
and annoyance at the time, gave way, and the tumor
tore itself loose from its connections. Fearing hemor-
rhage, I kept hold of the remains of the pedicle, but
very little bleeding followed, and I could jBlnd no vessel
requiring ligature.

" It is difficult to account for the large quantity of
ascitic fluid which was met with, unless there were
some secondary deposits of cancerous matter on the
peritonaeum, but the history of the case Avould hardly
lead to that supposition. The pre=ence of a consider-
able amount of serous eOusion in the peritoneal cavity
has, however, one advantage in cases of ovariotomy —
it seems to render the membrane less likely to take on
acute inflammation, its delicate secreting surface having
undergone some change, and after the removal of the
ovarian disease it does not seem to be re-secreted.

" In some of the medical journals a case of ovariot-
omy has be?n reported (extracted from an American
periodical), in which Dr. Julius F. Miner removed a
very large ovarian tumor by enucleation, without either
clamp, ligature, or cautery, and without hemorrhage.
When I commenced the above operation I iiad no
idea of imitating his proceeding, but when the tumor
(to my horror at the time) enuclea:ed itself, and there

appeared to be no bleeding from the pedicle, I deter-
mined to follow his example, and leave the torn
surface unsecured, thinking that the ri>k from hemor-
rhage was less than that from inflammation from the
presence of a foreign l)ody in the peritoneal cavity.
My ca.se turned out successfully, and I think I .should
venture to repeat the proceeding in .some special cases —
for instance, Avhere the pedicle does not appear to be
vascular — when the attempt might be made to tear the
tumor gently from its connections fin the same way
as adhesions are generally separated), but a firm hold
should be kept of the pedicle, so that it might easily
be secured in case of bleeding." — liritish JfedicalJour-
nal. — limithiraile's Retrospect for July, 1871.

Upon these fact-* I based the conclusion that the
pedicle in ovariotomy can be safely separated from the
cyst, and left without ligature, clamp, or cautery, thus
avoiding many dangers attending it. At first this
proposition Avill appear startling to surgeons who have
tied large vessels in the operation, or have witnessed
the fearful hemorrhage which sometimes takes place
from slipping of clamp or ligature; these will regard it
with incredulity, and, perhaps, Avithout trial look upon
it as wholly impracticable. I should myself, probably,
be among this number, had I not had opportunity to
demotistrate to my own mind, certainly, its entire
feasibility.

The ovarian tumor is composed of a firm, dense fibrous
cyst, containing fluid of varied color and composition.
It may, and it may not, have a solid portion, but usu-
ally it docs haA'e more or less of a body, the remnant
of an enlarged or degenerated gland. Upon the surface
of this smooth, dense fibrous cyst are spread out the
vascular and cellular tissues which compose the pedicle,
but only the terminal branches of the vessels enter this
cyst; the vessels may be quite large at their origin,
but soon they are numerously divided, and enter the
cyst, if at all, of capillary size. The attachment of the
pedicle to the cyst is more easily broken than any one
Avould mistrust who has not attempted its separation
in the manner described, and I am confident that the
same efforts Avhich are made to break up the adhesions
to the peritonaeum, omentum, and other parts, if ex-
tended to the pedicle, anmII be equally successful. The
finger should be gently introduced under the centra!
portion of the pedicle, and followed out along the fasci-
culi of A'essels as they extend over the sides of the cyst;
nothing can be more easy of execution or more readily
accomplished.

If this method can be adopted without hemorrhage
or other difficulty, its advantages are apparent.

The pedicle can then be returned into the abdominal
caA'ity Avithout any of the objections which have been
urged against this procedure. There is no ligature to
be discharged by the ulcerative process, or to become
encysted, or to induce inflammation. There are no
purulent or inflammatory products to be in any way
removed or provided for ; the pedicle is wholly a living
tissue, and h.TS no irritative qualities which render its
return to the abdominal cavity objectionable. This
cannot be said of it when treated by any other knoAvn
method.

My object will be fully answered, provided the feasi-
bility of enucleation in OA-ariotomy is shown with suffi-
cient clearness to obtain trial by surgeons. It is now
believed that all or nearly all cases will admit of it, or
of this general plan at least, perhaps varied to suit cir-
cumstances ; and that, Avhere practicable, it is the least
objectionable of all known methods. Prof. E. M. Moore,
my colleague, has suggested that if alter separation, as
described, there is any slight or troublesome hemor-
rhage, the different fasciculi, or the various parts which

THE MEDICAL RECORD.

have extended over the walls of the cyst, may be braid-
ed, causing in that manner arrest of hemorrhage upon
the principle of acupressure. Again, provided this meth-
od in any case should fail, the plan of arresting hemor-
rhage by acupressure or torsion, or separate ligation of
any vessel which might seem to require it, witli thread,
silver Avire, or other material, may yet be tried, may
indeed be adopted as aid to the operation by enucleation.
The advantages of this procedure are sulficiently
obvious to all surgeons of experience in this operation;
and the feasibility of the method being granted, little
else need be said to insure its universal adoption.

(Driijinnl Cccturcs.

SCLEROSIS UTERI:

ONE OF THE SEQUELS OF PUERPERAL METRI-
TIS.

A CLINICAL LECTUKE,

By Prof. ALEXANDER J. C. SKENE, M.D.,

AT THE LONG ISLAND COLLEGE HOSPITAL. BROOKLYN, N. Y.

(Reported by K. S. Bunker, M.D.)

Gentlemen: You will readily call to mind the patient
who had endometritis, giving rise to monorrhagia, and
I trust you also remember the clinical fact, then so
strenuously insisted upon, namely, that menorrhagia,
not accounted lor by any other conditions, is a common
and most valuable symptom of endometritis.

In direct and striking contrast with that case, I
present you one to-day, not of such frequent occur-
rence as the former, but presenting, nevertheless,
points of extreme interest in its pathology and clinical
history.

This patient informs us that she is 35 years old, has
been pregnant five times, and has given birth to four
living children. While j^regnant at the seventh month,
with her fourth child, she received an injury which
caused her to give birth to a dead foetus a few days
afterwards.

During her fifth pregnancy, four years ago, she
received a shock from seeing a friend in a convulsion ;
labor came on immediately, and she was delivered of a
seven months' child.

Soon after her confinement she complained of pain
and tenderness in the region of the uterus, followed by
fever and delirium. These sjanptoms extended over a
))eriod of three weeks, and there can be little doubt,
from the history given, that she had acute puerperal
metritis, which lelt her health permanently impaired.
Since that time her menses have been irregular, scanty,
and attended with pain. At times she has a menstrual
molimen, but no catamenial flow. During the last year
she has menstruated only twice, the last time three
njonths ago. So much for the previous history of the case.

She now suffers from extreme debility and anaemia,
as you can see by her general appearance, and com-
plains of ill-de6ned aching pains throughout the pelvis,
but more especially in the sacral region ; and occasion-
ally she has very slight leucorrhoea. Her digestive
organs are also very much deranged, and her nervous
system, from the joint action of disease and drugs, is a
miserable wreck.

By physical exploration I find that the uterus is en-
larged, being an inch larger than normal. The body
and cervix are tender to the touch, and the sound,
carried into the cavity, gives extreme pain. The cer-
vix is indurated and smooth, and the os is smaller and
more circular than is usually found in those who have
borne children.

Exploring the cavity with the sound, I find that
while the long diameter is considerably increased, the
antero-posterior and lateral diameters are relatively,
indeed absolutely, shortened. The uterine walls ap-
pear to lie in close contiguity, so that it is impossible to
turn the sound far in any direction.

These signs obtained by the probe are of vast impor-
tance, for they indicate clearly that the enlargement of
the uterus is due to an actual increase in the loalls of
the organ, and not a mere expansion of its cavity, as in
the case of endometritis, which I showed you the other
day. In other words, the growth is concentric, not
eccentric.

The cervix, as seen through the speculum, is notably
pale; the os is small, with its lips curved inward. This
retraction, or drawing inwards of the os, is confirmatory
of the opinion that the Avails of the cervix are enlarged
more than the mucous membrane of the cavity. When
the mucous membrane of the cervix is swollen, and the
walls remain normal, the lips are enlarged or pouting.

Briefly, then, the physical signs indicate that there
exists a condition of unusual hardness and enlargement
of the uterine Avails, while the relative or even actual size
of the cavity is lessened. The uterus is also anaemic, as
you knoAV from a glance at the cervix. And, before
closing the history, let me attract your attention to the
fact that our patient has amenorrhoea — a condition that
is much more common among the young than Avith
those AAdio have borne children.

NoAV you cannot fail to have observed that this case
presents many points of resemblance to that of endo-
metritis, AA'hich occupied your attention at our last lecture.
It is on account of these resemblances that I present
you this case to-day. By placing them in juxtaposition,
as it Avere, AA'hen the subject is still fresh in your memory,
you Avill be better prepared to study the points of dif-
ference; for both the past history and the present con-
dition shoAV that the cases are essentially different.

This patient's trouble began Avith acute inflammation
of the uterus; the other's did not. This one had
amenorrhoea; the other had menorrhagia. In the case
before us the uterine Avails are enlarged and the cavity
diminished, the reverse almost of Avhat obtained in the
the other. The uterus, in this case, is indurated and
anajmic ; in the other it Avas relaxed and highly con-
gested. These are plain outline distinctions, easily
recognized at the bedside, and characteristic of almost
opposite pathological conditions.

Excluding, then, the only uterine disease that might
lead us into error, and basing our opinion on the clinical
history and physical signs, Ave are compelled to pro-
nounce this a case of Avhat is usually knoAvn and
described as " cJtronic metritis."

But I fear the term "metritis" will lead you astray.
It certainly does not give you a true idea of the patho-
logy of the disease — at least, if you recognize inflamma-
tion only by the presence of hyperemia, the exudation
of lymph, suppuration, etc. In this case Ave have no
such evidence of the inflammatory process; the present
condition is not that of an inflammatory disease. It
bears no more resemblance to ordinary inflammation
than the stricture of the male urethra does to an acute
gonorrhoea. Nor is the condition that of induration
the result of the inflammatory process. That usually
results in the contraction as well as hardening of the
tissue in Avhich fibrin is effused. Noav, in the case
before us, you Avill observe tAVO conditions not often
associated except in malignant disease, namely, hard-
ening with increased size of tissue. Clinically considered,
this condition is not unfrequently obser\-ed associated
Avith a history and symptoms such as Ave gather from
this patient, and in the absence of any name to indicate

THE MEDICAL liECOliD.

the condition. I venture to suggest that of HclfrusU — a
term nlroaily fiuniliar to you aMlesi'^niiting morbid con
ditions of other organs similarly allectfd.

I conii'ss to you my dislike to introducing new terms
into tlie literature of gyna3cology, and certainly would
not if I did not think the one usually eni|iloyed, namely,
''chron c metritis," gives no true idea of the nature of
the lesion.

The term sclerosis simply moans hardening, and when
applied to the inter-cellular connective tissue, it includes
also thickenitig or growth of this structure. It resL-mbles
the condition described by Virchow as ''nutritive irri
tation of connective tissue." Your knowledge of
anatomy will enable you to estimate the relations of
this tis-ue to the varied structures of the body. In its
normal stale it is an exceedingly delicate structure, and
is e.vteiisively difl'used in all parts of t!ie body. It is
the bond of union to the framework of the body as the
plaster is to the bricks; it is the delicate curtain upon
which the minute capillaries are spread ; and it follows,
of course, that the increased growth of this connective
tiisue takes place at the expense of the fibro-muscular
tissue of the uterus, a condition of local anieinia is pro-
duced b}' pressure on the capillary vessels, and I need
scarcely add that function and force are correspondingly
destroyed. This lesion has been specially studied of
late as it occurs in nerve-centres. Hypertrophy of the
" neuroglia," or connective tis.sue in patches, gives rise
to a condition resembling locomotor ataxia.

Now the result of this same proliferation of the con-
nective tissue cells, from some previous spur of excite-
ment, is precisely what we find in this uterus. We
have the '* nutritive irritation" of Virchow, all'ecting the
connective tissue cells at the expense of the other
structures of the part, and not simple induration from
previous inflammation. The organ is rendered ab-
normal in size, dense in structure, brittle in quality, and
is anaemic or bloodless.

In tlie older pathology we have no word that repre-
sents this condition. We can scarcely believe that the
process is merely one of exudation of lymph into the
tissues of the uterus, for that is usually followed by
more or loss contraction ; nor can we for a moment
believe that there is excessive cell-growth from mahg-
nant tendency. Thanks to our German brethren, they
have pointed out and accurately described the lesion,
and applied to it the name of "sclerosis." And no
other term, in my judgment, so perfectly represents a
certain class of uterine diseases, a typical case of which
is now before you.

I would not be understood, however, as denying
that there is inflammatory exudation. On the contrary,
there is every reason to suppose, from the natural his-
torj' of the disease, that there is more or less effusion
of inflammatory lymph into the tissues of the uterus.
But the hypertrophy of the cellular tissue, and conse-
quent enlargement of the organ, are so much more
prominent characteristics of the disease, that I have
selected the term .sclerosis, rather than metritis, to
describe it.

It would be interestiu:? in this conned ion to study
how the lesions of sclerosis uteri are developed in
their natural order of sequence; but time will not
permit at present. Let me refer you for information
on this point to a most admirable article on " Chronic
Metritis in its Relaiiuns to Malignant Diseases of the
Uterus," by Dr. Xoeggerath, of Xew York. You will
find it in the American Journal of Obstetrics for Novem-
ber, 1869. I will read you a brief extract : —

'• The disease in question is the combined result of
sub-involution of the uterus, and a process of exudation
which takes place in the tissues of the uterus immedi-

ately after delivery, in consequence of puerperal fever.
This int'Trui)tion of retrogressive metamorpho.-is takes
place whenever the natural involution of the uterus is
interfered with by some injurious influences, so tha!
the absorption of the exuded mass depof-iied between
the muscular elements cannot be properly accomplished.
This results in the development and permanent deposit
of cellular tis-iue within thj walls of the utern.«."

Just here there comes up a question to which I can
give but a single remark at jiresent: Doe^ .'■clerosis
uteri arise exclusively from puerperal metritis? Or
may it be developed from other morbid influences ? Dr.
Noeggerath sa^'s he has never seen the disease occur a.s
a sequel of any other afifection. My own experience
accords with his. We should naturally suppose, how-
ever, that long-continued hyporaemia and nervous irrita-
tion might favor the proliferation of the connective
tissue cells in tlie uterine walls, as well as elsewhere;
but we have no proof as yet that sclerosis uteri is de-
veloped in that way.

Finally, sclerosis uteri is a permanent lesion. There
is no tendency to restoration of normal tissue; on the
contrary, there is lowered vitality of the part, and con-
sequent tendency to still further degeneration. The
afiection exemplifies the general pathological law, to
which there is no exception, that whenever the tissues
of an organ are changed from their normal type, that
change is towards degeneration, decay, and death.
Hence the practical fact that these cases of ."Jclerosis are
peculiarly prone to such diseases as epithelioma, cauli-
Jlower excrescence of the cervix, etc., etc.

Malignant disease of the uterus can often be traced
back through a natural history such as I have pointed
out in this case; and that the tendency to malignant
action is hastened in such cases by the injudicious use
of caustics, I have no doubt. It is important, there-
fore, that we shall early recognize the difficulty and
avoid a course of treatment that must end, sooner or
later, disastrously to the patient.

Trusting that you comprehend the pathology of scle-
rosis uteri and its relation to other morbid states, I will
now briefly recapitulate some of the leading points in
the diagnosis of this affection.

1. A clinical history indicating that the patient has
previously had puerperal metritis, followed by an im-
paired sUite of health.

2. Constitutional symptoms such as occur in chronic
forms of uterine disease.

3. Derangement of function: usually irregular,
scanty, and painful menstruation. The pain continues,
as a rule, through the whole period of menstruation,
and may be likened to an exaggeration of the ill feelings
of an ordinary menstruation. By these peculiarities it
may be distinguished from the dysmenorrhoea caused
by flexion of the uterus. In this latter afifection the
pain is that of intense uterine colic, and is usually
limited to the beginning of menstruation, decreasing or
disappearing when the flow begins.

4. Enlargement and induration of the uterine wall?.

5. Increased length of the uterine cavity, without
increase of the lateral and antero-posterior diameters.

6. Ansemia of the uterus, indicated by the amenor-
rhoea, and the pale appearance of the cervix.

7. Absence of cervical disease, such as occurs in hy-
peraemic and inflammatory aflfections.

8. The slight retraction of the lips of the os, and the
small diameter of the cervical canal in proportion to the
increased size of the cervix.

THE MEDICAL RECORD.

The Medical Record:

A SEMI-MONTULY JOURNAL OF MEDICINE
AND SURGERY.

GEORGE F. SHRADY A.M., M.D., Editor.

Published on the Isl and \^lh of each Month by
WOT. WOOD & CO., 27 Great Jones Street, N. Y.

]SreAV ^^ork, INIarcli 1, 187;

THE RELATIVE mOREASE OF POPULATION.

ALTHOUGn the subject of the relative increase of popu-
lation among the higher and lower orders of society is
one of vast importance, yet it has been terribly neg-
lected. While men are discussing the great question
of the rise and fall of nations, they seem to ignore the
one great fact, where the men of which nations are
made are to come from.

Dr. Nathan Allen, of Lowell, is one of the few who
have given the subject a scientific and patient attention.
He has studied the subject as it ought to be studied,
statislically ; and he has discovered th'at the average
number of children to American families in New Eng-
land is but three, or three and a half, against an average
of eight to families of a corresponding social scale a
century ago. Population can hardly be kept up among
the cultivated classes, unless an average of more than
three children are born to a family. This, then, is
the great problem of the future ; it is a problem
which no nation and which no government has yet
solved. Historians have long debated the question,
what was the reason for the decline of Greece and
Rome. Prof. Seelye, the eloquent author of Ecce
Homo, has answered this question : " Rome died for
want of men." " The human harvest was bad."

Dr. Allen, in a very suggestive paper, based on Prof.
Seelye's essay on ^^ Roman Imperialism," has shown by
quotations from standard authorities that, in all proba-
bility, Greece died for the same cause as Rome. The
nation died because the individuals that composed it
died, and there were none to fill their places. The
most pertinent fact concerning these statistics is, that
they are in the main true (for Dr. Allen's opponents
have made no headway against him), and they are con-
firmed by common observation. Practitioners in New
York and vicinity tell us that they find not more than
an average of three children in a family. Among the

higher classes, very few families have more than five
children, very many have but one, and altogether too
many have none.

We should be glad to hear from practitioners in the
country their views on this matter. A nation can do
without high culture; it can do witliout extensive ter-
ritory; it can do for a lime without religion; it can. like
China, do without a pure morality, but human beings it
must have. Questions of science, of education, of gov-
ernment, of religion, of morality, etc., are trifles com-
pared with this one great question of population. Un-
less we are greatly in error, the population in distant
country-places increases among the higher classes much
more slowly than it did one hundred years ago. The
time must come when the labors of Dr. Allen and the
few interested in this matter will be appreciated, when
their errors, if they have made any, will be corrected,
and the whole subject will be scientifically investigated.
The time must come when physicians will evince a dis-
position to employ a portion of their leisure in studying
the great laws of population.

THE PROPOSED DRUG EILL.

The Drug Bill now before the Legislature has been
modified in several important particulars which will,
we doubt not, render it even more acceptable to the
pharmacists of our city. Instead of the several
grades already mentioned we have now but two, viz.,
graduates in pharmacy and licentiates of pharmacy.
The former grade comprises all those Avho hold diplo-
mas from recognized colleges of pharmacy, and the
latter includes such as have not enjoyed the privileges
of these educational institutions, but who have obtained
a license from the present board, or who shall pass the
examination before the proposed new board appoint-
ed by the members of the New York College of Phar-
macy. The other grades are, so to speak, abolished,
and in their stead simple assistants are named who
are only responsible through their principals. It is
also provided that these so-called apprentices shall have
served with some practical pharmacist four years be-
fore they shall be eligible for examination as licentiates.
The provision for an annual registration is also abolished,
as it has been objected to by many of the leading apo-
thecaries as an unnecessary measure and an irksome
obligation. Senator Weismann, Chairman of the Com-
mittee of Health, is understood to favor these modifica-
tions, as being best calculated to simplify the opera-
tions of the proposed board, and do away with the ob-
jections urged against the passage of the bill. The
pharmacists may rest assured that no effort will be
wanting on his part to jealously guard their interest,
despite the pressure brought to bear upon different
members of the legislature by members of the present
Commission. The saving for the coming year of seven-
teen thousand dollars to the city should of itself be a
conclusive argument in favor of the repeal of the pres-
ent law, irrespective of the principle of placing a

THE MEDICAL RECORD.

premium upon lopitimale education, wliicli is one of the
main and truly commendable features of tlie proposed
new law. We sympathize with the pharmacists in
their struggle for their rights, and sincerely hope that
they may triumph over all opposition.

TUK QIKSTION OF QCARANTINE.

The question of Quarantine has of late commanded
more than ordinary attention. The medical profession
have had the matter under serious discussion, and some
valuable papers bearing upon the contagiousness of yel-
low-fever, cholera, typhus fever, and variola have been
read before the New York Academy of Medicine, with
the result of placing upon record many important and
interesting facts. The paper by Dr. Theodore "Walser,
in the present number of the Record, is a contribution
to the subject of more than ordinary value at this time,
detailing, as it does, the experience of one who has so
long and so conscientiously served the Quarantine De-
partment. "We take occasion to commend his sugges-
tions to the serious attention of our legislator?, who
have it in their power to modify the laws governing
that department.

A MODEL HOSPITAL REPORT.

The Report of the Imperial Rudolph Hospital, of Vi-
enna, for the year 1870, which we have just received,
is truly a model of its sort, and we take this occasion to
commend it to the attention of the large number of
gentlemen who appear to think that the possession of
hospital appointments for Ufe, to the exclusion of oth-
ers, entails upon them no responsibility towards the less
fortunate members of the profession. In this report
the usual tables of statistics are supplemented by a
careful working up of each class of disease treated in
the institution during the year, and by reports of all
cases which hive any features of interest. Throughout
the volume there is an entire lack of that self-glorifica-
tion which eliaracterizes some of the so-called "hospi-
tal reports " -which have appeared in our own large cit-
ies, and which, instead of being what the term would
indicate — a report of all the work done in the institu-
tions during the time specified — are little more than a
collection of monographs upon difi'erent subjects, by
•several gentlemen, some of whom may never have had
any connection with the institutions whatever.

FORCED MEDICAL SERVICES.

Toe /n^encfawf of Valparaiso, by a decree of date Octo-
ber 11th, requires all the doctors of the city to submit
to a weekly " turn,"' when they are to hold themselves
in readiness to serve the pubhc, whenever called on,
from 12 P.M. to 7 a.m., for an entire week, and this
without any remuneration whatever, in case of the
applicants being unable to pay them. They are also
required to take turns in attendance at a public dispen-
sary, also without remuneration. Two of the sixteen

doctors of the city suspended all work for several
days, but resumed practice again, witli the understand-
ing that the " turn " should not be enforced, and the
authorities are endeavoring to get physicians from
abroad to remove to Valparaiso, on a contract to give
their professional services for a term of years, under
such laws, decrees, and ordinances as regulate the
exercise of the medical profession in that country, and
are to receive free pa.=sage to Valparaiso, and two
hundred dollars per month, for the first three months.
Before being permitted to practice they will (the cor-
respondent of the Medical Times and (j'azette writes)
be required to pass a medical examination in Spanish.

On its face this is a very unjust and arbitrary law,
and it is not to be wondered at that the profession as a
body rebel. But aside from this, there are some modi-
fying circumstances to be taken into account, which do
not ordinarily obtain in medical communities. In the
first place, the practice of medicine seems to be monopo-
lized by sixteen gentlemen, the provisions of the law
regulating said practice being sufficiently stringent to
prevent the ingress of any ambitious outsiders. The
queition is certainly a suggestive one, whether these
gentlemen should not be willing, in lieu of such a
monopoly, to give some of their services gratuitously to
the State. The law supports their interests on the one
hand, and it would appear to be nothing more than a
just return for them, even at the risk of personal in-
convenience, to conform with a law which has the
ostensible object of protecting the commonwealth.
Again, it would seem to be a reflection upon the pro-
fession of that place that any law should be deemed
necessary to compel their members to attend the poor ;
but we are disposed to take a charitable view of the
case by assuming that a law based on such grounds is
really uncalled for. In spite of all this, it would seem
that our brethren of Valparaiso are not so alive to their
purely professional interest as their protest would lead
us to expect, else the obnoxious decree would not com-
pel them to assemble at least twice in each year for the
purpose of discussing matters of medical interest to
themselves and to the State.

THE HEALTH OFFICER OF OCR PORT.

The power of the Health Officer of this Port to quaran-
tine vessels at his discretion has been very much
abused, and besides opening wide the door for bribery
in every conceivable shape, it has been conducive to
much shameful oppression to our merchants. This, it
seems, from facts brought to light by the recent inves-
tigations of the Quarantine Sub-Committee of the Le-
gislature, is particularly the case with the present
incumbent. The system of hghterage, as now enforced
under his direct patronage, is an abomination, and calls
loudly for a remedy. The practice of fumigation, as
carried on by him, is also deserving of the serious atten-
tion of such as have it now in their power of remedying
the impositions connected with it. At present vessels

THE MEDICAL RECOKD.

are kept unnecessarily long in quarantine, and fumiga-
tion is practised when there is no otlier apparent reason
for the same tlian the mere object of increasing the
emoluments of the officer by exorbitant charges.
When we add to this the fact as brought out in
the investigations of the Sub-Committee of the Lcgisla-
lature, that vessels held in quarantine are not uniVe-
quently released on the payment of a sum of money,
eveiy unprejudiced person has a right to suspect that
there is very good reason for the almost universal out-
cry among the merchants, of corruption and fraud.

In view of these charges, the profession owe it to
themselves to enter their solemn protest against the
course of the Health Officer of this port, and deny to
him the right to represent them as a faithful protector
of the health of the people on the one hand, and the
rights of the commercial community on the other.
Although, in a political sense, appointed as a representa-
tive medical gentleman, he long ago forfeited his right
to be so considered. His appointment to the responsi-
ble office was viewed by the respectable portion of the
profession of this city as an insult to their dignity.
The recent developments of corruption in his depart-
ment have in no way tended to alter professional opinion
concerning him ; and we speak the sentiments of our
medical brethren, when we say that his removal will
be one of the first of the important steps taken towards
remedying many of the existing abuses of the quaran-
tine. The profession as a body have a right to a voice
in this matter, and now seems to be the time when
its wishes should be heeded by the Executive.
{Since writing the above, and on the eve of going to press,
tue learn that Dr. S. Oakley Vanderpoel, of Albany,
has been nominated by the Governor, and confirmed by
the Senate, to take the place of Dr. Carnochan. The
profession have reason to congratulate themselves on the
change, and to express themselves as perfectly satisfied
luith the choice. Dr. Vanderpoel has held many offices
of trust, and to this, the most important of all, he ivill bring
a i-epntation for professional ability, and an unques-
tioned integrity of character.)

vol. VII. to end with the year.
It has been deemed advisable by the Editor and
Publishers of the Record to end the present volume
with the year. In order to do this to the best
of advantage to our readers, we have concluded to is-
sue four double numbers during the year. We give
the first of these with the present issue.

EetJtntJs antr notices of HJoolis.

A CLmiCAL Manual op the Diseases of the Ear.
By Lawrence Turnbull, M.D.

The general practitioner stands very much in need of
all the information he can obtain upon diseases of the
ear, provided it be real information, founded on the
actual experience of some accurate observer. A book.

professing to treat of diseases of the ear. should do so
in detail, and should not be a mere compilation of what
has been written upon the subject by other authors,
and this is all that the work under consideration is,
though it (.laiiiis to be more. Dr. Tuinbull is mistaken
in thinking that the day has passed fir medical men to
allirm that they " know but httle of the anatomy and
physiology of the ear, and nothing about its diseases."
Most of the general practitioners are lamentably igno-
rant of the subject; and if they do not all confess their
ignorance, do what is worse by concealing it, and do
their patients a great deal of harm. The " scientific
reformation " mentioned by Dr. Turnbull has not, un-
fortunately, extended as far into tlie rank;: of the gen-
eral profession as he imagines. The author's manner
of expressing himself is generally obscure, and some-
times almost incomprehensible ; e. </., in speaking of the
mode of introduction of the Eustachian catheter, he
mentions " two new forms with drawings from nature,
the results of experiments on the cadaver and living
subject." Now whether the ^' forms " refer to the
catheter or to the shape of the mouth of t':e Eustachian
tube it is difficult to say. There is but little original
matter in the book, and this of but slight account.
The author quotes constantly and profusely, but does
not always give his authority, or where the original
can be found. He introduces entire pages from the
works of other authors, but does not give the title of
the book or journal. The plates in the front of the
book are lithographs from wax preparations, and can-
not compare in truthfulness and value with Riidinger's
photographs I'rom the cadaver. Wax preparations, no
matter how carefully prepared, give a faulty conception
of fine organs like the ear. The author has a way, in
his anatomical descriptions, of introducing a sentence
with a partial quotation, and finishing it with some re-
marks of his own, instead of giving the quotation in its
entirety, which seems to us decidedly unjust to the
writer quoted. He makes tlie connection too close
between catarrhal otitis media and disease of the bony
structure of the ear. He errs in stating that the most
fiequent cause of disease of the mastoid cells in child-
hood is cold, contracted after birth, and followed by
discharge ; for in almost all cases not dependent upon
the eruptive fevers the cause should be sought in the
strumous or syphilitic diathesis. In the chapter on
otitis media and interna, Case I. is reported as " otitis
interna of author, followed by death." Now this is
certainly ambiguous, and likely to lead one to suspect
a ghostly authorship for the book.

In the chapter on chronic aural catarrh there are
eleven pages quoted entire from G-ruber's book on Dis-
eases of the Ear, which can scarcely be accounted for
except as a means of filling up the chapter.

The author devotes quite a long chapter to afiec-
tions of the ear dependent upon disorders of the
brain and nervous system, but as he tells us nothing,
and makes several misstatements, the value of the
chapter is rather questionable. One good point about
the book is the frequent mention and high praise ac-
corded to Dr. Roosa, for all that he has done to ad-
vance the science of Otology. Dr. Turnbull has evi-
dently read a great deal, and is tolerably well acquaint-
ed with the subject, but his work as a compilation is
of much more value than as an original treatise.

Transactions of the American Ophthalmological
Society.

Tnis organization is composed of fifty-one active, and
seven honorary members, representing the majority of
the leading ophthalmologists of this country. The

THE MEDICAL RECORD.

oiphtli unnnnl meetino: was hold at Newport, Rliode
Islaiul, July 20th and 21st, 1871. The subjoined inter-
esting and scientific papers were presented : Report on
iho progress of Oplillialinology, by B. Joy .lefVi ies, M.I).,
lios'ton, occupying filtv-nine of tlie 149 pages ; An Ap-
paratus for Cutting Microscopic Sections of Eyes, by
Kdward Curtis, M.D., New York: General Syphilitic
liillaMinintion of the Eye, by Franci.s DelafieKi, M.D..
New York; Halo round the Macula Lutca, by I']dwara
Ct. Loring, M.I)., New York; A Scheme to Aid in Ex-
amining and Il"coriiing Cases of Functional Trouble of
the Eye, by Henry D. Noye?, M.D., New York; On
the Tables Given by Loring and Knapp to Show the
l)i*pl:icement of the Retina in Eminetropia, by O. F.
WaJswoitli, M.D., Boston; Variety of Forms of Small
Tencils of Astigmatic Ray.s, by G. Hay, M.D., Boston;
The Retina an Asymmetrical Surface by Russell Mur-
doch, MIX, Baltimore, Md. ; An Additional Method
for the Determination of Astigmatism, by Geo. Straw-
bridge, M.D., Philadelphia; On Astigmatism as an Ac-
tive Cause of Myopia, by John Green, M.D., St. Louis,
Mo. ; Remarks on Cataract, by Edward G. Loring
.^LD., New York ; An Apparatus for Testing the Per-
foplion of Color, by Henry D. Noyes, M.D., New
York; Description of a Jaeger Ophthalmoscope, as
modified by George Strawbridge, ^I.D., Philadelphia;
(runshot "Wound of the Brain, Ibllowed by Fungus
Cerebri, and Recovery with Hemiopsia, by "W. W.
Keen, M.D., and William Thomson, M.D. ; Detachment,
of the Retina, ■with Laceraiion at the Macula Lutea, by
Henry D. Noyes, M.D., New York; Report of Passa-
vant Operations with and without Ether, and also
under Nitrous Oxide, by B. Joy JefTries, M.D. ; Case
of Readjustment of the Levator Muscle of the Upper
Lid, by John Green, M.D., St. Louis, Mo.; Additional
Note upon the Use of Atropia in the Treatment of In-
cipient Stabismus, by the same author; Paralysis of
the Trigeminus, followed by Sloughing of the Cornea,
by Wm. F. Norris, M.D., Philadelphia; A Case of
Congenital Fissure of the Lids, by W. W. Scely, M.D.,
Cincinnati ; C mgenital Absence of both Eyeballs— .-
Two cases, Reported by Geo. Strawbridge, M.D.,
Philadelphia.

The following gentlemen v.-ere re-elected as Oflicers
for the ensuing year: President. Dr. H. W. Williams,
of Boston; Vice-President, Dr. C. R. Agnew, of New
York ; Recording Secretarjj and Treasurer, Dr. Henry
D. Noye?, of New York ; Corresponding Secretari/, Dr.
H. Althof, of New York ; Committee on Progress of
Ophthalmologi/, Dr. B. Joy Jeffries, of Boston ; Pub-
lishing Committee, Drs. Loring, Roosa, and Noyes.

On the Use op the OriiTnAi.MoscopE ix Dlseases
OF the Neuyous System and op the Kidneys.
By Thomas Cliffoud Allbutt, MA. , M.D., Cantab.

It is with great pleasure that we call the attention of
our medical brethren, general practitioners, as well as
specialists, to this valuable contribution of Dr. Allbutt.
It aids very materially in filling up a long-existing
vacuum in ophthalmic medicine; for although many of
the subjects contained in it have already been di,?cussed
in scattered articles in the periodicals, most of them
have been in a foreign language, and this is the first
attempt that has been made to collect in a single volume
the views of distinguished writers. The value of the
work is very nmch enhanced by the careful investiga-
tions of Dr. Allbutt himself who has brought to the
work an amount of painstaking labor, caution, and fair-
ness of discussion truly admirable. The diseases treat-
ed of in the separate chapters are all represented Ijy a
large number of cases contained in the appendix, and

in reviewing the work we shall discuss each chapter by
itself.

In .speaking of the anatomy of the optic nerve and
retina, the author gives a very correct idea of the caluseB
of optic nerve-trouble, viz. : that it is " due to its own
structure and attachments, to its rich va.scularity, its
large share of connective tissue, and its cxlei»sive rela-
tions with part? at the base of the encephalon ; and not
in any way to its especial altitude as a sensi', not even
in such disease ■! as locomotor ataxy." He emphasizes
very properly the necessity and importance of examin-
ing the field of vision in all cases where the optic nerve
is affected. He calls special attention to the great vas-
cularity of the optic nerve, indirectly connected with
the cerebral vasimlarity, and to a great degree inde-
pendent of the retinal circulation ; but omits mention
of the intimate anastomosis between the retinal and
nerve-ves-sels, whi:;h is a very important point. The
anatomy of the optic nerve and its intimate connection
with the brain is very carefully and accurately given,
and this latter point cannot be to highly valued nor too
of! en brought to our mind. Dr. Allbutt very justly
calls attention to the small radiating vessels of the di.sk,
and their increase in size and number in congestion
and inflammation. He discredits the statement that
the .sympathetic nerve exerts any influence in produc-
ing a change in the di.<k and retina. One of the most
importnnt points in this cliapter is the distinction which
the author draws between anosmia and atrophy of the
disk, and between partial and complete anajmia, and
a'so that between ischa?mia papilla; and optic neuritis.
Ischajmia papilla; is confined to the disk, and is a con-
gestion of the vessels; it occurs much more commonly
than neuritis, and in it the nerve-tubes undergo little or
no injur}'. In true neuritis, on the contrary, the con-
nective elements sufl'er first, then the nerve-fibres, and
the subsequent congestion is slight. It affects the
nerve-trunk, and hence is called " neuritis a.scendens."
Dr. Allbutt thinks that the " consecutive atrophy " of
Hughlings Jackson, distinguished by the ragged edges
and blurred outline of the disk, is not distinct from the
simple or progressive atrophy, distinguished by its
clean-cut outline and brilliant appearance, but is merely
an earlier stage of it, before the exudations have been
absorbed.

The article on primary atrophy of the optic nerve is
very complete, and proves the author to be possessed
of nice powers of observation. He gives four causes
for this form of atrophy, viz. : 1st. Any tumor or patch
of inflammation in the course of the nerve behind the
eye, which severs the nerve-fibres and leaves the se-
parated parts to wither. 2d. Destruction of the centres
of vision making the nerve useless. 3d. A sclerotic
process associated with patches of sclerosis elsewhere,
as in the spinal cord or encephalon. 4th. Deficiency
of nutrition, as is seen in senile degeneration of the
arteries and in embolism.

The cliapter on the relation between certain intracra-
nial disorders and affections of the optic nerve and
retina is the most voluminous, and perhaps the most
important in the book. It is very carefully written,
and presents a mass of very interesting statements
illustrated by cases in the appendix. Many of the
statements are recognized as facts by ophthalmologists
generallj', but some of them cannot be considered as
satisfactorily proven until fortified by a larger number
of cases. We agree most cordially with Dr. Allbutt,
however, when he saj's, " the occurrence of papillary
ischfemia or optic neuritis in any person ought to awak-
en the gravest suspicions of cerebral disorder, and the
occurrence of simple atrophy should suggest great
watchfulness."

THE MEDICAL RECORD.

Tn speaking of tlie influence of epilepsy upon the
appearance of the disk, Dr. AUbutt thinks that cerebral
venous congestion may have the same effect upon the
disk as cerebral anii^mia, but that an ophthalmoscopic
examination should always be made in the intervals of
the attacks as well as during tlie convulsion. He also
thinks that the anivmiaof the disk, as well as the con-
gestion, may persist for hours, and even days, after the
attack. In tubercular meningitis, the author thinks
that the exudation at the base of the brain may press
upon the cavernous sinns, or the inflammation may
involve it, in which case we have ischemia papiUce; or
the inflammation may creep down the nerve and cause
neuritis, both of which states may be, and generally are,
followed by atrophy. We think Dr. AUbutt attributes
too much importance to the appearances of the disk in
cases of children suffering from symptoms of meningitis,
for the congestion of the disk may be caused by the
simple straining in the vomiting, and is by no means
necessarily connected directly with brain trouble.
Still the author is very cautious and fair in all his state-
ments, and very correctly asserts that tubercular menin-
gitis is only revealed to the ophthalmoscope when it
invades the anterior and inferior parts of the encepha-
lon near the optic tracts.

In hydrocephalus Dr. AUbutt says that ischremia
papillfc is the earliest change ; but subsequently the
disks and retina} become wholly disorganized, and the
optic nerves atrophy from pressure or from abolition of
their function. The changes are mainly due to pressure
or severance of central connections, though, perhaps,
some inflammatory action and proliferation may also be
present.

The section upon intracranial tumors constitutes al-
most a monograph in itself, and exemplifies perfectly
the caution and strictness with which the author selects
his own cases, and sifts the evidence of authors. He
admits that we cannot say when to expect eye-symp-
toms in the course of intracranial tumors ; what conclu-
sions to draw from them when present, or how to ex-
plain their occurrence in many cases ; but insists that
by the use of the ophthalmoscope we do gain very
important information. We have here to answer two
questions, viz. : Is there an encephalic tumor present?
and if so, what is its size and situation ? It being con-
ceded that changes in the optic nerve are a frequent
accompaniment of tumors, we must inquire what are
the conditions of this coexistence. The author gives in
full Benedikt's hypothesis of the cause of the ophthal-
moscopic appearances, and then very carefully shows
what he considers to be its fallacies. In answer to
Benedikt's first point, that trophic disturbances are due
to disturbances of the circulation set up by direct or
indirect pressure, he admits that pressure will set up
these changes, but asserts that the agent in many cases
is not mere local pressure, but a general elevation of
intracranial tension due to excess of contents. He
admits Benedikt's second point, that a neuro-retinitis
caused by a tumor can be entirely reduced without any
diminution in the size of the tumor; but says it is not
common, and asserts that the growth of a tumor is at-
tended with destructive effects which might soon com-
pensate the encroachment of the tumor itself Bene-
dikt's third point, that it is difficult to see why the
congestive phenomena should set up mechanical hin-
drance in no other circulation, and should cause pressure
upon no other nerve-district than that of the eye only,
jie explains away by the fact that a rapidly growing
tumor would compress the surrounding tissues and
greatly increase tension, W'hich would become specially
manifest in the disks on account of the multipl5nng
action of the scleral ring. In answer to Benedikt's

fourth point, that a neuritis dcscendens can only be
admitted if the amblyopia sets in without ophthalmo-
scopic appearances, and the changes in the dis-ks show
themselves gradually ; he again insists upon the neces-
sity of distinguishing between ischtcmia papilke, where
the disk alone is affected, and that condition in which
the whole length of the optic nerve is in a state of
active hypenttmia with cell-proliferation. We should
always remember that neuritis is not so much a disease
of the nerve as of nerve-investment. Dr. AUbutt in-
sists very properly that neuritis, properly so-called,
does not coexist with non-inflammatory intracranial
disease, but that the latter rather gives rise to ischic-
mia, while, on the other hand, primary neuro-retinitis
accompanies inflammatory disease. The passive hyper-
aMiiia, helped by the action of the scleral ring, produces
the choked disk, while the phenomena of neuritis point
to a biological process of cell-proliferation due to in-
flammation, that is, to meningitis, or, in rare cases, to
encephalitis. The atrophy of the optic nerve, found in
connection with intracranial tumor, Dr. AUbutt holds
to be due to the crushing or dividing action of tumors
of the base, or from the pressure of hydrocephalus upon
the optic tracts or centres. The division of the intracra-
nial cavity into seventeen regions, in order that we may
know what symptoms follow the growth of a tum.or in
any of them, we do not think is justified by experience,
and hence is to be regarded as unnecessarily complicat-
ing. In referring to tumors of the tubercula quadrige-
mina. Dr. AUbutt does not go so far as to assert that ob-
literation of thequadrigeminal bodies must cause blind-
ness; but he does think that injury of these bodies
causes amaurosis, which also accompanies the destruc-
tion of parts lying near them, and that here loss of
vision preceded a progressive atrophy of the optic
nerves. One assertion of the author will be admitted
by all ophthalmologists, viz. : that the nearer the tumor
approaches to the anterior and middle fossai of the
skull, the more frequently does amaurosis occur, and in
a tumor of the middle fossai the optic nerves seldom
escape. In cases of persons struck down by apoplexy,
the author has frequently found a deeree of nerve atro-
phy, attended with some degree of loss of vision, and
thinks it due to atheroma of the encephalic arteries, and
may be recognized in some degree as a forerunner of
apoplexy. This, however, needs confirmation.

Dr. AUbutt calls particular attention to the ten-
dency of the optic nerve to atrophy in almost all cases
of general paralysis. The change is sometimes simple
white atrophy of the optic nerves, more commonly
preceded by redness, and not infrequently results in
complete amaurosis. The pathological characters are :
dwindling of the proper nerve-structure, and over-
growth of the connective tissue. The author gives
several explanations for the change, viz. : 1st. If lu-
minous impressions are perceived in the cortical mat-
ter, it might be expected that as the perceptive centres
wasted in disease, the optic nerves would waste from
disuse. 2d. The degeneration of the optic nerves may
be due to atheroma of the vessels. 3d. The most pro-
bable explanation is to be sought in the peculiarity of
the primary morbid change and in the anatomical char-
acter of the tissues which it invades. It seems safe to
say that the optic nerves are more liable to sclerosis
than other nerves, which we should expect from their
vascularity and richness in connective tissue.

The ophthalmoscopic signs of disturbance of the
optic nerve and retina in diseases of the spine are
divided by Dr. AUbutt into two kinds: 1st. Simple or
primary atrophy of the nerve, sometimes accoiupanied
by slight hyperaimia and active proliferation, which
make up chronic neuritis ; and, 2d. A characteristic

THE MEDICAL RECORD.

liyponcniic change, occurring only in cases of injury to
the si»iiie, in whieli tlio arteries becnnic inihstinj^uish-
abK», wliih' llic veins are swollen and tortuous, and the
disk assumes tlie appearance of isi-hiuniia. In trying
to explain how these changes are cau.ved, Dr. All-
butt objects to Wharton Jones's view, that in injury
of the spine the sympathetic nerve is involved, and as
this governs the blood-vessels, and the latter the nutri-
tion, therefore the changes are due to irritation of the
sympathetic; but he admits that he is not able to pro-
pound any more satislaotory theory. He thinks atro-
phy of the disks is always ihn? lo slow degeneration of
the cord, while tlie ciioked disk and neuritis arc not
peculiar to spinal disease, but are met with in ence-
phalic disorders ; and the neuritis is seen in injury of the
cord, particularly in sclerosis of the posterior columns.

In disorders of vision associated with all)uniinuria,
Pr. Alll)Utt distinguislies two kinds, viz. : 1st. Attacks
of partial or absolute blindness, coinciding with the
uraMnic poisoning state; 2d. Impairments of vision,
which advance more gradually, last longer, and are
dependent upon visil>lo chaiiges. The first, called
nrieiiiic amaurosis, may exist alone, or may precede or
complicate the second or retinitic amaurosis. It may
precede any symptoms of renal disorder, and cannot be
demonstrated by the oplithalmo?cope. The changes of
the second form are in the retina, are partly I'atty,
partly a sclerosed action, and involve the nerve-tissue
as well as the connective-tissue framework of the retina
and the adventitia of the vessels.

Speaking of leuctemic retinitis, the author thinks that
the hypothesis of adenoid tumors in the retina of leucfe-
mia must be abandoned, as not based upon sufficient evi-
dence, and that we must fiill back upon the belief that
leucivmic. like albuminuric retinitis, is a combination
of hemorrhagic with irritative events; but that in both
diseases we are as yet in want of further evidence as to
the mode and causation of the latter. As regards the
form of retinitis associated witii syphilis, the author is
strongly inclined to coincide with Mr. Oglesby in at-
tributing to it peculiar destructive appearances. We
do not agree with him on this point, but think the
retinitis to be similar in appearance to other forms
of simple retinal inflammation, and that a diagnosis of
a specific cause can only be made from coincident
general symptoms, though we are aware that many
good observers, particularly among our German con-
temporaries, agree with Mr. Oglesby.

The chapter on toxic amaurosis is very interesting.
Speaking of alcohol poi^oninir, tlie author very justly
says: "As in ur&imia, so in this, there is an amblyopia
potatorum with ophthalmoscopic sign^ and an ambly-
opia without them. Tlie latter defect is not rare, and
may be due to congestion of the choroid, with conse-
quent pressure upon the layer of rods and cones of the
retina. The other kind of amblyopia seems to depend
on this same congestion, witli consequent tissue-degen-
eration of the optic nerve. Dr. AUbutt passes over the
subject of tobacco-amaurosis very lightly, regarding it
as not yet satisfactorily proven. In lead poisoning
he thinks that the atrophy of the optic nerve some-
times met with is occasionally preceded by a stage of
subacute irritation.

In the article on hypnosis and narcosis. Dr. Allbutt
speaks of two kinds of sleep, viz. : Sleep, artificial or
natural, due to anaemia; and sleep, artificial or natural,
due to venous congestion of the capillaries; and he
thinks it probable that narcotics produce their effect j
by venous hyperaemia of the brain.

In conclusion, we wouLl most cordially recommend
Dr. Allbutt's book to the perusal of every practitioner,
as a very valuable contribution to medical science. |

TiiK PiivsiriAN'H Daily PorKicT RKfonn : Comprising
a Visiting List, etc. By S. W. IJi ti.kh, M.D. Phila-
delphia, 1(S71.

Tme objectionabl(! feature of this book is the amount
of printed matter which it contains. A memorandum
with its pocket full of cards, prescription blanks, etc., is
at best an awkward burden to have always in one's
coat-pocket, and is a sullicient reason for leaving out
such matter as tables and directions for urinary analysis
— which can only be undertaken in a physician's office
— and lists of remedies and doses other than such as re-
quire .special care in their use. If a list of new reme-
dies is added, it should only include such as are yet on
trial, and regarding whose merits the majority of phy-
sicians are imdecided. Such a list, with doses and the-
rapeutical indications as far as known, might aid in ad-
vancing greatly our knowledge of such remedies ; but
we can hardly think it necessary to put into such a
category the bromide of potassium, as regards iLs influ-
ence in epilepsy, pumpkin seed as an anthelmintic,
ipecacuanha for dysentery, M ousel's salt as a styptic,
or carbolic acid as a disinfectant. Whereas, we would
expect to see something said about chloralum and ni-
trite of amyl, which we do not in the present instance.
That])ortion of the book devoted to the visitinglist, re-
cord of obstetrical cases, vaccinations, deaths, etc., is
very commendable, the visiting list especially so, as it
can be used for any year, from any date, and for any
number of patients, without waste of room. The use
of springs in the cover to keep the book closed, thus
doing away with the need of an elastic band or tuck,
is a very great convenience.

PuT.MONARY CoNSUMPTiox ; its Nature, Varieties, and
Treatment, with an Analysis of One Thousand Cases to
exempHfyits Duration. By C. J. B. Williams, M.D.,
and Charles Theodore Williams, M.D. Philadel-
phia: Henry C. Lea, 1873. 8vo, pp. 315.

This volume, containing as it does a summary view of
the opinions of a gentleman whose "experience in dis-
eases of the chest in private practice during the last
forty years has probably not lieen exceeded by that of
any other physician," complemented by statistics of 1,000
cases selected from his note-books during a period of
twenty-tAvo years, its practical value to the medical
practitioner is very great, independently of any appro-
val or disapproval of the author's theory of consump-
tion. This tlieory, which tlie senior author has ad-
vanced for more than forty years, and which receives
support from modern pathological research, is, " that the
tuberculous and kindred lesions whicli cause consump-
tion of the lungs, arise from a degradation of the plas-
ma or nutritive material by which old textures are re-
newed and new ones formed." "This material, or pro-
toplasm, is seen in an inflamed part of a living animal
in the form oi sarcophytes or bioplasts^ multiplying and
clinging to the insides of the blood-vessels, penetrating
their walls, and emigrating by a movement of their
own into the adjoining tissues. Like other forms of
animal and vegetable protoplasm, these sarcophytes
have vital endowments of motion, growth, power of ab-
sorbing and digesting various matters from without,
and of multiplying by division, and probably also by
gemmation and endogenous proliferation."

These sarcophytes or pale corpuscles exist naturally
in very small numbers in the blood, but in greater
abundance in the lymphatic system, and they may
multiply and decay independently of inflammation,
constituting a true scrofula; Avhen overcrowded and
hardened from loss of their plastic and self-sustaining
power, they become the gray tubercles, obstructing the

THE MEDICAL RECORD.

adjoining tissues, and irritating them, and in them-
selves prone to decay.

The causes of consumption are classed as follows: —

1. General causes, -vvliicli by their weakening in-
fluence on the constitution generally predispose to con-
sumption. Such are family predisposition, want of
pure air and good food, continued fever, scarlatina,
measles, cessation of discharges, miscarriages, bad con-
finements ; and over-lactation, mental depression, damp-
ness of habitation.

2. Local causes, the effects of which are limited at
first to the lungs, but may at a later date extend to the
system. Tliese are: attacks of bronchitis, hooping-
cough, and croup; attacks of pleurisy and pneumonia;
attacks of asthma; trades and occupations giving rise
to a dusty or gritt}^ atmosphere ; injuries.

Tlie 1,000 cases selected for statistical purposes are
taken from notes of about 25,600 cases, accumulated
during some thirty years, representing all the cases
of any gravity in which the author has been consulted
in private practice. The average duration of the 1,000
cases was nearly eight years. Tliey are divided into
two groups; phthisis of inflammation, and phthisis of
constitutional origin. The first group includes varieties
designated as fibroid, suiDpurative, chronic pneumonic,
scrofulous pneumonic, catarrhal, albuminous, hemor-
rhagic, and others more or less mixed, and in their
course assuming more or less of the form of constitutional
phthisis. The second group includes acute tuberculosis,
chronic tuberculosis, and scrofulous consumption. These
are represented as varieties of one common disease,
varieties not always distinct and easily passing into one
another.

With regard to the treatment of consumption, our
author, on taking a retrospect of an experience of forty
years, can trace a remarkable improvement in its suc-
cess. This is due, in great measure, to the use of cod-
liver oil, in connection with the liberal use of nutritious
food, and the administration of tonics. The tonics on
which most reliance is placed are quinine and iron, but
they are not deemed useful as long as there exists any
inflammation, active or intercurrent. Under these cir-
cumstances ealumba, cascarilla, and chiretta are pre-
ferred. The oil recommended is the pure pale oil. The
best time for its administration is immediately after a
solid meal, or at or before the meal, for those who pre-
fer it so. It thus forms part of the chymous mass, less
apt to rise by eructation, and less apt to disorder the
stomach. It is given with an aromatic bitter, acidu-
lated with a mineral acid, and, where a tonic is given,
it is added to the dose of oil, the dose of which should
rarely exceed a tablespoonful twice or thrice a day.

With regard to climate, it is advisable that the
patient should breathe as pure an air as possible, and that
its beneficial influence should be increased by such
gentle and varied exercise in it as his strength and the
conditions of his organs will permit.

The separate points of special forms of phthisis and
their management are treated of fully and in sufficient
detail.

Consumption is such a fearful destroyer of human life,
that every valuable communication concerning it de-
mands the serious attention of the physician. He will
find much to admire, and much to follow, in this useful
summary of a well-known aud distinguished author.

A Practical Treatise on Brigiit's Diseases op
THE Kidneys. By T. Gr.\inger Stew.\rt, M.D.,
F.R S.E. Second edition. New York : William Wood
& Co. 1871.

We welcome this work as a model of what a second
edition should be. The revision of the first edition,

which appeared in 18G8, has been very thorough. The
size of the volume has been nearly doubled, the addi-
tions consisting mostly of reports of cases which are of
great interest, and strongly enforce the views of the au-
thor on certain disputed points in the pathology of
Bright's Diseases. A supplementary chapter has been
added on " The Complications of the Different Forms
of Bright's Disease," and two new lithographs have
been introduced. But, besides these improvements,
the work bears evidence of careful attention to the
minuter details of revision. Sentences are reconstruct-
ed, positive statements qualified, new modes of treat-
ment suggested ; in a word, the author gives us the re-
sults of three years' additional study of these " well-
known but little understood diseases." To review this
book as its merits deserve would require more time
and space than we can command, but it may be of in-
terest to notice a few points in pathology in which the
author differs from the views expressed by Dr. Dickin-
son in his work on Albuminuria. Dickinson adopts the
classification of Virchow, according to which the differ-
ent forms of Bright's Disease are distinguished by the
tissue primarily and principally affected. When the
renal tubules are the principal seat of the morbid pro-
cess, we find the large red or the large white kidney
the result of an acute or of a chronic tubal nephritis;
when the affection starts with and is chiefly confined
to the intertubular matrix of the organ, we have the
contracted, granular or cirrhotic kidney; thirdly, the
amyloid or " depurative" disease, which primarily affects
the walls of the smallest arteries, especially the convo-
lutions composing the Malpighian tufts, but subsequent-
ly extends, by exudation of the amyloid material, to
the intertubular s{)aces, and may ultimately lead to di-
minution in the size of the organ through contraction
of the exudation. Stewart's classification is widely dif-
ferent from this, but is, Ave are convinced, more in ac-
cordance with recent pathological views. His division
is as follows : —

" 1st. The wflammatory fo7-m, of which there are
three stages.

a. That of inflammation.

b. " " fatty transformation.

c. " <' atrophy.

2. The waxy or amyloid form, of which also there are
three stages.

a. That of degeneration of vessels.

b. '■ " secoiidary changes in the tubes.

c. " '• atrophy.

3. The cirrhotic, contracting or goidy form ."
According to the author, an atrophied kidney may

belong to any of these three divisions; Dickinson
would exclude it from his first division, tubal nephritis.
Stewart thus expresses his views in regard to the rela-
tion between tubular inflammation and atrophy of the
kidney. " The first stage is that of inflammation, in
which exudation is poured out, and a destruction of the
epithelium takes place. This exudation, affecting a
large number of tubules, leads to enlargement of the
organ, and also to fatty degeneration of the epithelium ;
its absorption or removal leads to ultimate atrophy."
The granular or " uneven surface is due to the irregular
affection of the tubules, some being involved and under-
going atrophy while others escape, . . . and not to the
contraction or outgrowth of connective tissue."

Dickinson dissents emphatically from the view that
a granulated contracted condition of the kidney may
result from a tubal nephritis. " If," he says, " in sim-
ple tubal nephritis, the loss of the contents of the tubes
ever suffices to reduce the once enlarged kidney below
the natural bulk, such a result must be of rare occur-
rence, since no unequivocal instance has fallen under

TilE MEDICAL RECORD.

the observation of the author." Case No. XIX. in the
present work bears directly upon this point. Wc have
not the sjiace to quole it, but any one interested in
renal i)ath'ilogy would be amply repaid by carefully
studying,' Dr. Stewart's commentaries upon it. That
thi.s furm of atropliy is not of fretpient occurrence is
doubtle.-s duo to the f.ict lliat patients with this variety
of Brighl's Disease j^encrally recover or die before this
stage of degeneration is readied. The microi^cope will
generally show, in a kidney thus contracted, a relative
excess of connective tissue, but this degeneration may
be distinguished from a true cirrhosis by noticing the
considenvble amount of disease in the tubes not yet ob-
literated, and the absence of the characteristic broad
masses of connective tissue found near the surface of a
cirrhotic kidney.

Our autlior vigorously combats Dr. Dickinson's views
as to the pathology of the amyloiil disease. He agrees
with him that the amyloid material consists of an al-
buminoid sub.-^tance probably delicient in alkah, but he
denies tliat it has any necessary or constant relation to
the suppurative process as indicated by Dickinson's
unfortunate term " depurative disease." In 18 cases
coming under the author's observation, only C> were
found, after careful examination, to have suffered from
a past suppuration. ]Ie maintains, moreover, that the
disease is essentially a degeneration of tissue, and in no
sense an infiltration by any ingredient of the blood.
'"That it is not an infiltration." he says, "will become
apparent if we consider the parts it affects. We have
seen that it affects the cells of the liver. This might
well be a result of infiltration, for we constantly see the
same structures loaded with fat which has been poured
out from the blood. But far more generally through-
out the body it affects small arteries. How is this to
be explained on the infiltration theory ? How can it
happen that the small arteries — nay, the small arteries
of certain organs— nay, the middle coat of the small ar-
teries — should be the chosen seat of deposit of a ma-
terial poured out from the blood ? If it be poured out
from the blood, why does it so generally confine itself
to the walls of arteries and unstriped muscular fibre ?
Why does it not infiltrate the parenchyma of organs?
Why does it, in the intestine, as it flows from the
blood, confine itself to the walls of small vessels, to the
muscles of Briicke, to the epithelium ? Why does it
not pass out among the cellular tissue of the villi, and
become deposited there ? These questions can scarcely
be answered by those who hold the infiltration theory.
On the other hand, how exactly the characters corre-
spond to those of degeneration, — certain tissues always
primarily aflfected, those tissues presenting every de-
gree of alteration from the slightest to the most dis-
tinct, the surrounding parts remaining unaffected. The
closest analogy exisis between what is seen in this
and in the atheromatous and calcareous degenerations,
the former affecting the inner coat of arteries, and es-
pecially the deeper layer.«, the latter, when primary, af-
fecting the middle coat. Both are independent diseases
originating in the tissues, not even secondary results
of infiltration."

By the cirrhotic kidney our author understands " an
hypertrnphij of the connective tissue, and a consequent
atrophy of all the other structures." He objects to the
term granular kidney because the same condition is
found in the third stage of the inflammatory and amy-
lOid diseases; to the term gouty kidney because the dis-
ease often occurs independently of gout ; to the term
contracting kidney because contraction is not peculiar to
this variety; and to " intertubular or interstitial nephri-
tis" because there is no evidence of inflammation. He
ho'ds to the non-inflammatory nature of the morbid

process, and denies that there is any evidence that an
inflammatory exudation takes place into the intertubu-
lar spaces. Further investigations are needed in regard
to the essential jihenomena of inflammation before this
question can bo discussed in an entirely satisfactory
manner.

Wc congratulate the publishers on the creditable
style in which the work is is.sued. The cloth binding
has the American merit of being firm and substantial.
Why is it that our English bretliren persist in so fast-
ening their cloth bindings that they fall to pieces after
the book has been used half a dozen titucs? The
paper, letter-press, and lithographs, plain and colored,
are excellent, and we lieartily rejoice that the time has
come when a physician can gratify his taste for hand-
some books in his medical as well as in his literary li-
brary.

The Science and Practice op Suugery. Illu.strated
by four hundred and seventy wood engravings. By
Fkedeiuck James Gant, F.R.C.8., Surgeon to the
Royal Free Ho.spital ; formerly Surgeon to Her Majes-
ty's Jlilitary Hospitals, Crimea and Scutari. Philadel-
phia : Lindsay ic IJlakiston. 1871.

In the preface of this work, wc are told that now many
years have elapsed since a new systematic work repre-
senting the science and practice of surgery has ap-
peared in his country, and that it is the aim of the
writer to give a full but condensed embodiment of all
those changes in the pathology and treatment of inju-
I ries and diseases which the progress of surgery has
established. Evidently the intention of Mr. Gant has
been to make a big book, and certainly in appearance
it is very pretentious, to say the least. By gleaning
largely from the writings of English surgeons, and per-
haps chiefly from the articles contained in Holmes'
System of Surgery, the book has grown to one of con-
siderable size. Indeed, we nmst look upon it pretty much
in the light of an epitome of the more recent English
authors, and as such it must be regarded as a work of
no little value. In a book of this kind, however, we
think its value would have been greatly enhanced, if
the writings of Continental as well as American authors
had been a little more consulted. Had this been the
case, in our judgment both the pathology and the
treatment advocated in many affections would have
been more in keeping with the progress of science
than we find to be the case in many parts of this work.
Full and due credit has been given to all the sources
whence information lins been derived, and through-
out the work the author's own surgical experience
and pathological observations have been freely inter-
spersed.

The subject of inflammation is considered entirely in
accordance with the views which have been adopted
by most English writers, and differs but little, if at all,
from what was taught many years ago. We were no
little surprised that in this field the labors of the Ger-
man pathologists were hardly noticed. No reference is
even made to the researches in this direction by
Strieker, Recklinghausen, or Cohnheim. Should our
author even dissent from these views, he should, at
least, have acquainted the reader with the more
modern views on this important subject.

Tumors we find classified into those that arc localized
(not infiltrating), which includes some of the recurring
varieties, and into the infiltrating growths, as the varie-
ties of cancer. The whole subject of these grov/ths
is but briefly referred to, with the exception of that
of cancer, which is more fully and much more satisfac-
torily treated. While reading the chapter on tumors,
it is with difficulty that one can persuade himself that

THE MEDICAL RECORD.

he is not turning over the pages of Mr. Paget or Mr.
Moore's excellent treatises on this subject, as found in
Holmes' Suigery.

Were we to criticise the cbapter on syphilis as we
believe it deserve?, we should tuke up more space than
can be allotted for a notice of the whole work. Did
we desire to thoronghly confuse a student on the sub-
ject of syphilis, we could not succeed better than ask
him to read this chapter. Mr. Gant states his views
incline to the opinion '• that while the indurated chan-
cre possesses the greater power of producing constitu-
tional syphilis, and is thence the most freciuent cause;
yet that so/if chancres may also occasionally have this
causative relation. Hence, they also may be regarded
as forms of primary syphilis." We were no little sur-
prised to fmd the statement here made that a chancre
on the glans penis never acquires induration. Suffice
it to say, that this article savors more as if it came from
the pen of one whose information had been derived
from reading, rather than from actual experience in the
study of this disease.

While speaking upon the subject of the treatment of
erysipelas, especially in those cases where the skin is
tinged with a yellow hue, even when " verging on
jaundice," we must dissent from the view here ex-
pressed that this condition is best overcome by the re-
peated (italics our own) administration of calomel or
blue pill, to restore the secretion of bile. Cases present-
ing these symptoms which have passed under our ob-
servation Avould have exhibited a very unpleasant result
from such treatment.

Pycemia is treated not in accordance with the more
recent views that pathologists have advanced, and the
same is to be said in reference to phlebitis. When
describing the symptoms of pyaemia, no mention is
made as to the rapid rise of temperature, as indicated
by the thermometer just before and during the period
of chills, (fee. ; nor are the diseases which the student
might mistake it for mentioned, nor is he told the usual
duration of the disease.

The chapter on gunshot wounds is very meagre, and
certainly not such as we would have expected to have
emanated from one who has been a military surgeon.
Had some reference been made to the experience
gained in our late war in regard to these wounds, it
would have considerably enhanced the value of this
portion of the work — at least to the American
reader.

Injuries and diseases of the nerves are very unsatis-
factorily treated, and in no way is it a creditable chap-
ter to its author, not being up to the requirements of a
Avork of this kind. Little or nothing is said in regard
to wounds of nerves, and the various operations that
of late years have been performed for the relief of neu-
ralgic affections are not even alluded to.

The succeeding chapter, however, on aneurism, is
very well written. While referring to ligature of the
innominate artery, we find the statement made that it
has been tried in eleven cases, and that they were all
fatal. No reference is made to Dr. Smyth's successful
case, which we believe makes the twelfth reported
case of ligature of this vessel. Here, as in very many
portions of the work, Mr. Gant appears to have been
utterly ignorant of what has been accomplished in sur-
gery on this side of the water.

The chapter on fractures gives us a good description
of tliese lesions, and is well illustrated by the time-
honored woodcut?. The treatment, however, recom-
mended in this work must strike American surgeons in
many cases as somewhat antic|uated. For fractures of
the femur "we find that Liston's long straight splint will
be found most effectual in all fractures of this bone,

and extension is to be made by confining the foot to
the splint by a figure-of-eight bandage !

What has been said in regard to fractures applies
also to dislocations. The principal obstacle in reduc-
tion our author attributes to the muscles, and but little
reference is made to the ligaments, which we believe
at the present day are regarded by many as offering the
chief obstacles to reduction. No reference is made,
while speaking of dislocations of the hip, to Dr. Bige-
low's work on this subject, and only brief reference
is made to reduction by manipulation.

With regard to the chapter on diseases of the eye, it
may be considered as a slight improvement upon the
manner Avhich we find these diseases treated upon in
the majority of text-books on surgery. Had Mr. Gant
followed some other ophthalmologist than Mr. Dixon,
we have no doubt the chapter on diseases of the eye
Avould have been more in accordance with the present
state of ophthalmology.

Though this work is faulty in many respects and in-
vites criticism, there is much to be found in its pages
which will be very valuable either to the student or
practising surgeon. Under this head Ave would espe-
cially refer to the articles on resection of the joints, inju-
ries of the brain and spinal cord, together Avith the
subject of curvature of the spine, and the chapter on
the diseases of the genito-urinary organs.

Mkdical Thermoaietry, and Human Temperature.
By C. A. Wunderlicii, M.D., and Eda\^\rd Seguin,
M.D. New York : Wm. Wood & Co. 1871.

Within the past five years much attention has been
paid to the use of the thermometer as a means of in-
vestigation in clinical medicine and diagnosis ; and
though A'ery man}^ practitioners Avere convinced of its
value and utility, it has not as yet come into such ex-
tensive use as it undoubtedly Avill hereafter, as Ave noAV
have a concise manual on the subject to serve as a
guide in the study of its use. The observations pub-
lished in the Avork of Dr. Aitken Avere the first, we
think, of any importance to call the attention of the
profession to the real value of the instrument ; and
though, from time to time, we have had more or less
elaborate articles upon its use in various disea-es, we
Avere AvhoUy in Avant of a hand-book treating of the
AA'hole subject. Consequently, though the thermome-
ter is quite largely used here, it may be said, Ave think
Avith truth, that its use is nearly confined to thoscAvho
have had opportunities for the study of its applicabilit y in
the various large hospitals. Within a year Ave have had
a translation ot the encyclopaidic treatise of Wunder-
lich, which, besides being inaccessible to those Avho are
not subscribers to the publications of the Sydenham
Society of London, is objectionable on account of its
great length and detail, and will be consequently
of no reaf value to the majority of practitioners. To
render this Avork available to American practitioners.
Dr. Seguin has with great industry and care abridged
it very materially, and at the same time has enriched it
with a resume of his own extensive observations, and
the result is a A'cry convenient and comprehensiA-e
hand-book, Avhich is especially adapted to the Avants of
the busy practitioner. The Avork is divided into two
portions: first, the abridgment of Dr. Wimderlich's
treatise; and second, the supplementary chapters by
Dr. Seguin.

We find in the opening chapters a concise and brief
history of the instrument; followed by a consideration
of the fundamental principles and of the art of medical
thermometry, Avhich contain facts Avhich, Ave think,
should be "thoroughly mastered. The observations
upon local alterations of temperature in disease will no

THE MEDICAL KECORD.

doubt bo novel lo mnny, and should be rosul in connec-
tion with ihe ri-nmrks nia<lL' later on in the work by
Dr. Se;ruin, who has devisu'd the surface-thi'rniometer
to determine tliese local elevations. This instrument
has by the zeal and .-kill of Dr. Se-juin, been brought to
n hiph dcirree of perl'eolion, ami will no doubt be of
essential .xerviee in clinical study. Among the other
introductory chapters which deserve especial attention
are those treating of typical alterations and of the daily
fluctuations in disease. The various fel^rile diseases
are then treated of in their order, and the tliermonie-
trioal peculiarities of eacli clearly brought out.

The observations appended by Dr. Seguin are in the
highest degree practical, and materially enhance the
value of tlic work; indeed, wc rarely find a foreign
author's treati.se brought before the profession in such
a masterly manner. The work is profusely illustrated
by diagrammatic schemes, which add very much to its
utility.

The Sciences of Nature rersiis The Science of
Man. a Plea fou the Science of Man. By Noah
PoKTKit, President of Yale College. New York: Dodd
& Mead. 1M71. pp. !)8. An Essay delivered before the
Phi Beta Kappa Societies of Harvard and Trinity
Colleges.

Works of this class are much needed at the present
time, when books on metaphysical questions are ecarce-
ly intelligible except to the student. The subject is
treated in a popular and entertaining manner, and is
•well worth the attention of the general reader who seeks
amusement coupled with instruction. The larger
part of the essay is a terse review of the philosophies
of Comte, Mill, Spencer, Iluxley, Darwin, etc., and
demonstrates conclusively that they will not stand the
tests which they themselves apply "to otliers. The au-
thor shows that all other sciences rest upon the science
of man as the foundation, and that, without a know-
ledg3 of this as a basis to start from, the pursuit of the
others is difficult and uncertain.

The volume is correctly printed in clear type, on
good paper, and is one of the many valuable productions
which liave been recently published by this well-known
publishing house.

PKOCEEDrNGS OF THE ACADEMY OF NATURAL SCIENCES

OF PiiiLADEi.PiirA, Part II.— April to September,
1871. inclusive. Philadelphia, 1871 ; pp. 274.

Tins number of the published proceedings contains
several interesting articles ; for example, the paper of
Prof. Marsh On Some new Reptiles and Fishes from
the Crustacean and Tertiary Formations, discovered
during the exploration of the Yale Scientific Party in
the Rocky Mountain region, last summer ; On Remains
of Extinct Mammals from Wyoming, by Joseph Leidy,
M.D. ; and a paper by Elliot Coue.«, consisting of Notes
on the Natural History of Fort Macon, N. C, and vicinity
(No. 2). ' . J

Mr. Isaac Lea contributes the descriptions of twenty
new species of Unimidte of the United States; and Mr.
F. B. Meek, the descriptions of new species of fossils
from Ohio and other Western States and Territories;
and the notice of a new Brachiopod.

Twins in Pennsylvania. — The census statistics show
the following I'acts: One family in Pennsylvania is
credited with seven pairs of twins ; one with six pairs ;
and another with four pairs. The motlwr of the last
group has six other children, and is only thirty-eight
years of age. — Med. and Surg. Reporter.

llciu instruments.

A NEW NEEDLK-FOTirEPS.
Bv J. S. PROUT, M.D.,

HCnOEON TO THE DIIOOKI.YN ETE AKD EAR IIOKITTAU

TiiEHE are certain objections to nearly all of the needle-
forceps used ill operations on the eye, especially to
those which are closed with a spring catch. I have
seen the best of these, in the most skilful hands, tear
the needle out of the conjunctiva in consequence of the
jerk or jog communicated by the spring to the instru-
ment in releasing the needle. To obviate this objection,
Messrs. Tiemann <fc Co. made for me the forceps of
wliich the accompanying cut is a reduced representa-
tion. As now made, it is 4^ inches long, very light,
and when closed occupies scarcely more space than an
ordinary lead pencil of the same length. The figure
shows its construction and action so well that it seems
uimecessary to describe it. In u.se, the jawsgrasp the
needle very firmly, and are kept securely closed by
the sliding catch, upon the roughened head of which
the thumb rests. The elasticity of the arms of the
handle opens the jaws to the proper extent. The little
pin at the end is to prevent separation and lateral mo-
tion.

The forceps has very successfully stood the test of
use in my hands, and is found to be a favorite with
those who need such an instrument.

After it was made, I learned that the device for
separating the jaws was not new, as I had supposed.
I have seen since then a nearly similar needle-forceps
of prior construction.

ily friend. Professor Skene, tells me that this forceps
(of larger size, of course) will be a valuable addition to
the instruments used in operating on the perinaeum and
within the vagina.

Brooklyn, N. Y., Jiinnwy 6th, 1S72.

CURVILINEAR FORCEPS FOR FACILI-
TATING THE LIGATION OF HEMOR-
RHOIDAL TUMORS.

By WILLIAM BODENHAMEE, A.M., M.D.,

SEW SORK.

I WOULD respectfully call the attention of the profession
to the curvilinear forceps represented by the accom-
panying wood-cut. Its construction is exceedingly
simple, and its mode of action novel and effective. It
was expressly designed for the purpose of temporarily
compressing the basis of hemorrhoidal tumors, especially

THE MEDICAL RECORD.

when large. This compression it firmly and most ef-
fectually makes in a uniform manner, thus preparing,'
the tumor for the more easy and ready adjustment of
the ligature upon its already compressed and strangu-
lated base. By the use of this instrument tiie operator,
without the aid of an assistant, is enabled to apply,
adjust, and tighten the ligature with the greatest facility
and precision.

The instrument was not intended as an tcraseur, but
it will at once be perceived that it can be easily and
successfully so employed. It will also be readily ob-
served, from the construction and the operation of it,
that with slight variation it is peculiarly adapted as an
ovariotomy clamp. In this respect, if it is not supe-
rior, it is at least not inferior to any ovariotomy clamp
extant, so far as my knowledge extends. Should it
prove to be so it would be important, for a good in-
strument for such a purpose is just now a deside-
ratum, inasmuch as it appears to be the general opinion,
and gradually becoming the settled conviction, of the
most distinguished ovariotomists, that the very best
treatment of the ovarian pedicle is to clamp it, either
permanently keeping it external to the abdominal
wound, or clamp it temporarily until it is completely
ligated. It may also be applied to other and various
surgical uses.

It will be seen from the drawing that this instru-
ment, which needs but little explanation, has two
blades curved on the edges, with handles curved on the
flat. One blade ha= a fenestra its entire length, through
which the other must pass in approximating or closing
them. The coapting surfaces of the blades are rough,
so as to secure a stronger hold and prevent the tissues
from slipping. The handles are so curved that they do
not press upon or otherwise interfere with the sur-
rounding parts. The screw in the handles gives addi-
tional security during the operation, and obviates the
necessity of an assistant. The forceps are removed as
soon as the ligature is tightened.

The instrument was made by Iklessrs. George Tie-
niann & Co., 67 Chatham street, New York.

|3ro0rcss of ittetiical Science.

The following is an extract from a report of the (Jan.
12, 1872) meeting of the Society of Physicians of
Vienna, sent us by Dr. W. T. Alexander, of that place:

The Dr.\GNosi3 of Syphilis, from Microscopic Ex-
amination OF THE Blood. By Dr. Lostorfer. — For
a long time attempts liave been made to discover the
bearer of the contagion in syphilis. Hallier examined
the blood of those suffering from the infection, and dis-
covered a parasite, the micrococcus. The correctness
of this discovery was doubted from many quarters.
For this reason mainly the results of examinations of
blood have remained, until now, unsatisfactory. The
speaker believes that he has found the explanation of
this in the fact that the examiners did not work with
sufficiently high powers ; further, that the examinations
were almost entirely limited to /res/i blood, which was
believed to be more suited to examination. The speaker,
in his researches, had avoided both errors.

Dr. Lostorfer began his examinations in August of
the preceding j'ear, Prof. Zeissl having, with the
greatest readiness, placed the material of his division
at; his disposition. The blood was taken from sj'phi-
litic individuals, and after periods of from three to four
days Dr. L. found constantly present small, shining
corpuscles, on which he could sometimes discover
processes jutting out. It was proven that tlipse cor-

puscles increased by budding. New corpuscles were
formed in this way, which again increased by sprouting.
By the addition of different fluid.s, especially sugar-
water or Pasteur's fluid, these corpuscles became shriv-
elled.

This result was so constant that Dr. L. was enabled
to diagnose syphilis with certainty and precision, by
observing the development of these corpuscles. He
had undertaken eight or ten test examinations, which
were given him partly by Prof. Strieker and partly by
Prof. Hebra, and every time he told correctly, from
microscopic examination of the specimens, which blood
was taken from syphilitic and which from non-syphilitic
subjects.

After having in this manner found his discovery tried
and proven to be correct, he designated the little bodies
by means of which he could certainly diagnose syphilis,
as " syphilis-corpuscles." As regards their manner of
development, the speaker said that it differed according
to their number. In some cases more than filty were
seen in the field, in others a much smaller number.
He also perceived a difference in regard to the time of
their development. Sometimes they budded on the
third, sometimes on the fifth day ; in many cases,
indeed, in twenty-four hours. As regards temperature,
observation teaches that a too low degree of heat retards
their development, but that the process went on unim-
peded by variations of from 10 to IS'' Cent. Difler-
ences in the manner of sprouting were also observed.
Whether these syphilitic corpuscles are developed from
the disease, or whether their germs pre-exist in the
blood, and are only hastened in development by the
infection, is still unsettled. He hoped by further exam-
inations, in which he would be aided by Prof. Strieker,
to become able to settle this question.

Towards the close of his remarks the speaker
described the class of cases from which his examina-
tions were made ; they were patients from Prof Zeis.srs
division, suffering from the most diflerent secondary
and tertiary manifestations. It was noteworthy that,
as improvement took place under the use of various
anti-syphiUtic remedies, the syphihs corpuscles de-
creased in number in the same degree, and finally
disappeared entirely from the blood.

Prof Skoda took the floor in order to congratulate
Dr. Lostorfer upon his discovery, which would make
an epoch in syphilodology. He remarked that it was
unfortunate that Ave had no prizes to distribute, but
that in Paris Dr. L.'s labors would certainly be crowned
with a prize.

Prof Strieker confirmed the statements of the
speaker, and related the details of the manner in which
the specimens of blood were delivered to Dr. Lostorfer,
and how he from them designated those which had
been taken from syphilitic patients. He had added
some of his own blood to the number of the test pre-
parations, in order to have absolute proof that it was
not syphilitic.

Prof Hebra also confirms the favorable and surpris-
ing results of the test examinations. Kohn had also
later seen the same objects in syphilitic blood. It was
remarkable that Dr. Lostorfer recognized Strieker's
blood among the numerous preparations. He had ex-
pressed himself that " this specimen was Strieker's
blood; it contained so many dirty elements." There
must be, therefore, certain peculiar characteristics which
pertain to the blood of non-syphilitic subjects also, and
by which other dyscrasife are to be recognized. He
had been led by this thought to conceive the idea of
having the blood of small-pox patients examined in
the same manner, in order to discover if some specific
diagnostic signs could not be discovered.

THE MEDICAL RECORD.

DunETKS IX IxprA. — The subjoined intcrcstinj^ ar-
ticli' on diabetes occurs as an editorial in I'.ie Indian !
Medical Gazette, Calcutta, December 1st, 1871 : — 1

It seenn stianpe, considering tlie frequency with '
wiiieli diabetes is met with amon;^ tlic natives of this |
part of India, that so little should be known of its cir- I
eiimstances. In Dr. Gouverncur M. Siniih's latest and
most valuable corhniunication to the New York Medi- I
cal Society (should be New York Academy of Medi- '
cine), he remarks that, so sli-riit is his knowledge with
reference to the disease in India, that he can hardly i
determine if it even exi^t^s among the natives of the j
cotmtry. In New York, during the year 18G8, the '
ratio of deaths from diabetes to the population was I
1 in 100,000. We are certainly not in a position to
give any figures on this point, but our impression is that
among the upper and middle classes of natives in Cal-
cutta, almost every family has lost one or more of its
members from diabetes. We can at any rate assert
with confidence that the disease is frequently met
with among tlie classes referred to, l)ut as j'ct we are
absolutely ignorant of all that concerns its history from
a medical point of view, and we look to the native
medical practitioners of the place to enlighten us on
tho subject; many of them must have had very con-
siderable experience in cases of diabetes, and we
should very nmch like to get their opinions on several
points connected Avith the clinical study of this formi-
dable disease.

We might, in the first place, seek for information re-
garding any cases in which diabetes appears to have
keen an hereditary disease. A very remarkable in-
stance of this kind has, for example, been placed at
our disposal by Baboo Satcory Dult, and has reference
to one of the most highly respectable and influential
families in Calcutta.

No. 1, Baboo B — , died at the age of Go, of acute
diabetes, which lasted only twenty days.

No. 2, the eldest son of No. 1, died of chronic dia-

betes

No.
No,

3, the third son of No. ], had chronic diabetes.

4, the fourth son of No. 1, died of acute diabetes.
No. 5, a daughter of No. 1, now aged 65, has dia-
betes.

No. G, the eldest son of No. 2, grandson of No. 1,
di d of chronic diabetes.

No. 7, the second son of No. 2, has diabetes.

No. 8, the eldest son of No. 4, has diabetes.

In addition to the above, two widows of the family,
wives of No. 3, died of diabetes.

This is certainly a very remarkable case, for, as Dr.
Gr. M. Smith writes, there are very few reliable data
in relation to the hereditary transmissibility of diabetes.
There can be no possible doubt as to the above facts,
and it is just such an example of that kind of informa-
tion we are much in want uC.

Then, again, with reference to the relative frequency
of the disease among males and females. Dr. G. M.
Smith arrives at the conclusion that it is equally com-
mon among members of both sexes. We were in-
clined to think diabetes far more frequent among males
than females in this country. The case above stated,
however, rather points to the correctness of Dr. Smith's
opinions. Any facts bearing on this point would be
most interesting in a clinical point of view, as bearing
upon the etiology of the disease.

We should be very glad to draw forth information
from our native friends^ as to the influence of diet on
diabetes. Are the members of those sections of so-
ciety who do not abstain from animal food more sub-
ject to the disease than those who rigidly confine them-
selves, from childhood to old age, to amylaceous and

saccharine food ? This is a question which is of the
greatest interest, bearing as it does directly on tiie cir-
cumstances of the disea'^c, and the various theories that
have been advanced to account for it. The field of ob-
servation open to practitioners in this country is ab-
solutely unique in this respect, and can hardly have .
failed to attract the notice of some of our professional
brethren. Tlie mortuary statistics of the native army
and jails might very possibly afi'ord information to those
who have time and inclination to advance our know-
ledge regarding diabetes in India.

Abscess of the Skptim Narium. — Dr. D. 11. Good-

willie, of New York, reports the following : — Mrs. ,

aged 6G years, presented hcnself some time in October,
18G7, with an ab.scess of the septum narium, filling up
both nostrils. This was the result of an injury from run-
ning against an open door in the dark. The swelling
was siiining, red, tender on pressure, with fluctuation.
Inflammation extended to frontal sinuses, as she com-
plained of severe headache. Opened freely on both
sides with a lancet, and found the ab.scesses communi-
cated through the septum. Dressed by introducing
the point of a small syringe into the wound on one
side and washing out the cavity, the fluid passing out
by the other side. A tent was introduced by means of
a curved needle through the opening in the septum, the "
ends of wdiich passed out of each wound. Tent re-
moved on third day, and the wounds soon healed.

Sulphite of Soda in Variola. — Dr. Maurice Pflaum,
of Pitt.sbiirgh, Pa., comes to the conclusion that sulphite
of soda, given at an}' time before the eruption has fully
come out, will invariably cut short the disease, even
more eflectually than quinine does intermittent fever.

Yellow Fever — its Pathology and Treatment. —
Benj. S. Purse, ^I.D., of Savannah, G-a., Avrites: — I was
led to the consideration of this disease in the early
part of the past summer, by the fact of its prevalence
in the city of Charleston, S. C. I then arrived at the
following conclusions as to its pathology and treat-
ment, and determined to test their truth upon the
first opportunity: — Yellow fever is never endemic nor
epidemic except in localities in which malarial fever is
endemic. These two fevers resemble each other very
much in their symptomatology, and at times the diag-
nosis between them is impossible. This resemblance
is increased by the fact that the functions of the liver
are markedly disordered in both diseases. Owing to
these facts, even at this late date, there are physicians
who believe that yellow fever is but an aggravated
type of malarial fever. But they are essentially dis-
tinct diseases, originating from tino specific poisons.

The malarial poison acts primarily upon the sympa-
thetic nerve centres, and through them deranges the
functions of all the organs sustained by that system of
nerves, and is the onl}' true ^' nei-vous fever." The
yellow-fever poison acts directly upon the cell-structure
of the liver, tending to produce molecular death of that
organ. When the fimction of the liver is entirely sup-
pressed, that organ becomes a mechanical impediment
to the circulation, and as effectively so as a ligature
around the portal vein would ; because the portal
circulation is continuous with the systemic circula-
tion, through the medium of the capillaries, and the
capillary circulation is controlled by the cell-structure
which they supply. When the cells cease to perform
their function, their capillary circulation also ceases.
The suppression of the function of the liver in this dis-
ease, as a rule, is gradual, and is the result of the pro-
gressive death of the cells. In some cases, howeve r,
the liver is killed, as it were, by a blow, and the

THE MEDICAL RECOKD.

patient dies before those changes in its structure, so
characteristic of this disease, have been developed.

It is a general law of the body, that when any organ
has served its purpose, its cells undergo fatty degener-
ation and are absorbed, leaving its connective tissue to
mark its Ibrmer site.

This normal degeneration and absorption of organs
is caused by the tuilurc of their cerebro-spinal nerves,
which control their blood supply ; while their sympa-
thetic nervous inlluence being unimpaired, they do not
suppurate, but degenerate into a fatty condition. The
cells dying from inanition, the yeilow-fever poison pro-
duces this condition of the cells in the liver, but in a
different manner. In the former case the supply of
blood ceases, while in the latter the cells are paralyzed.
Carbonic oxide causes a similar paralysis of the blood-
corpuscles. When the circulation through the liver
ceases, the portal vein and all the veins emptying into
that vein become congested, until filled to their utmost
capacity. The capillaries connecting these veins with
the arteries, being unable to relieve themselves of the
vis a tergo, receive the full force of the heart's action,
which soon overcomes the comparatively slight resis-
tance offered by their simple attenuated walls; and
capillary hemorrhages take place from the mucous sur-
faces of the organs which supply the portal blood.
Each drop of blood, as it falls into the stomach and
intestines, is coagulated by the acid secretions there
met with, producing the material which is known as
'^ Black Vomit" and "Black Vomit Stools."

Disorders of the liver always give rise to frontal
headache, and the pain is in proportion to the acute-
ness and severity of the liver disease. In agreement
with this rule, yellow fever is characterized by a pecu-
liarly intense frontal headache. The albuminuria is
caused by the liver disease. All cases of albuminuria
Avhich are not caused by disease of the kidneys jjer
se, late pathologists generally agree in ascribing to
some as yet not definitely ascertained disorder of the
liver. My opinion is, that it is caused by a gradual
degeneration of the cells of the liver. An analogous
disease is described by Dr. Flint, Sr., Avhicli he calls
"Degeneration of the Gastric Tubules." It is a dem-
onstrated fact that the albuminous principles of the
blood are converted, by their passage through the liver,
into the saccharine principles, which in their turn are
decomposed in the pulmonary circulation. When
either of these organs fails, the excess of albumen or
sugar, as the case may be, is exci'eted by the kidneys.
The albumen, generally, does not appear in the urine
until about the third day. The pulse, as a rule, does
not exceed one hundred, and is full and hard, indica-
ting plethora of the blood-vessels.

This plethoric condition is the result of the two fol-
lowing causes: 1st. By the inaction of the liver, the
volume of the blood is not reduced by the conversion
of its albuminous principles into the substances which
are excreted by the lungs, kidneys, and skin. 2d.
While the excretions are lessened or entirely suppressed,
the lymphatic or albumen producing organs continue
comparatively active. These two causes co-operating,
produce a fulness of the systemic circulation, notwith-
standing the excessive congestion of the portal circula-
tion.

I suggest the following treatment, believing that if it
be commenced with early in the disease, it will exer-
cise an almost specific influence. As soon as the
patient is seen, without regard to the s'age of the dis-
ease, apply a large warm poultice to the epigastrium,
repeating from time to time if necessary. Fjfteen min-
utes after the application of the poultice, administer
one teaspoonful of each of the following solutions, in j

an ounce of water. Repeat trie same dose every hour
until cinchonism is produced.

I?. Potass brom ^ i.

Aqua ? iv.

M. Sig. : Teaspoonful every hour.

I^ Quinia sulph 3 i.

Arom. sulph. acid f. 3 ij.

Tr. opii camph..

Aqua an f r i.

'M. Sig. : Teaspoonful every hour.

When cinchonism is present, continue the bromide
potassium alone every hour, giving only an occiisional
dose of the quinia solution. If necessary, relieve the
bowels by the Seidlitz or other saline, or by enemata.

The above combination of quinia, arom. sulph. acid,
and tr. opii camph. has never failed, in my experience,
to stop the nausea and vomiting so common in mala-
rial fevers. I have repeatedly used it with patients
suffering with high bilious fever, whose stomachs were
so irritable that upon the least attempt to swallov/ even
cracked ice, produced violent retching and vomiting,
and in several instances a slight hemorrhage from the
stomach, who were immediately relieved by ihcjirst
dose of the remedy. It is one of the surest, quickest,
and most powerful diaphoretics, the third or fourth
dose usually causing a profuse perspiration. I have
frequently subdued in twelve hours severe bilious
fevers of three and four days' duration with it alone.

This combination meets three of the indications in
the treatment of yellow fever, viz. :

1st. It relieves the nausea and vomiting. 2d. It
produces a powerful action of the skin. 3d. It is a di-
rect tonic to the liver, the quinia having a specific
effect upon the sympathetic nerve.

Bromide of potassium is almost specific in albuminu-
ria. It almost uniformly produces absorption of drop-
sical effusions, irrespective of their cause, and without
sensibly increasing the secretions unless they have
been suppressed. It relieves congestions in every part
of the body, particularly of the brain. It is the remedy
in congestive and nervous headaches. It is a poAverful
sedative ^to the brain and spinal axis. It produces a
sedative action on mucous membranes. It will relieve
suppression of the urine. Possessing these thei-apeutic
properties, bromide of potassium meets the other two
indications in the treatment of yellow fever, viz. : 1st.
The intense frontal headache. 2d. The albuminuria
which is always developed in grave cases. For the
albuminous feature in this disease, I give the bromide
upon the theory that, as it is curative of albuminuria,
by administering it in anticipation of this grave symp-
tom we prevent its development. If this were not suf-
ficient reason for its early use, we have still another, to
relieve the head symptoms.

Rachitis. — Dr. John S. Parry, Accoucheur of the
Philadelphia Hospital (Am. Jour. Med. Sciences) says
that this affection is not confined to children who are
inmates of hospitals ; moreover, it is not among the
poor alone that it is met with, notwithstanding Meigs
and Pepper cannot corroborate the experience of
Jenner, Avho has " very often seen it among tlie children
of the wealthy."

He has been irresistibly forced to the conclusion that
this disease is scarcely less frequent in Philadelphia
than it is in the large cities of Great Britain and the
Continent of Euroj^e, and that it should occupy just as
important a place in our mortuary lists as Hillier con-
ceives that it should in those of the Registrar-General
of England. It is probably true that the disease is
rarely congenital, but to say that " it is never born with

IIIK MKDir'AI. llEf'ORD.

the cliiltlrcn " (Bocrhoave's 1487lh npliorism), he
lu'lievcs all will have to admit is poin;,' too far. In
view of recor«K'»l facts, rachitis is sometimes, thoiif,'h
rarelv, confjonital, ami may result in considerable de-
formity even before birth. It is not by any means
rare durinp the early months of extra-ulenne life. Tiie
writer has met with uneciuivocal bending of the ril)8at
six weeks after birth. It is rare for it to be^-in after
tlic end of the first year. He ha3 seldom met with it
in a child in wliom no .symptoms of the aflV'ction pre-
sented themselves before this time. A common .source
of error is the failure in discriminating between rachitis
and mollities ossium. IJromfield, Sianley, Bcylard, and
Stewart have committed this error. Racliitis is proba-
bly more than any other a disease of childliood, and
even of infancy, while mollities ossium is an affection
of adult life.

AcostTE PoisoNi.vG. — Dr. Stephen S. Keenc, Prov-
dence, K. I. {Boston SM. and Surg. Journal), publishes
a case of poisoning by the external application of
aconite. For pain in riiiht side of the face, he applied
a portion of the following mi.Kturc to the affected part
by rubbing with the fingers. I>. Tinct. rad. aconiti,
Tinct. opii, il a 3 ss. M. One liaif hour afterwards he
was .seized with dizziness, nausea, dimness of sight,
cephalalgia, pain in back, with sensation of coldness
running along tlie spine, etc. One hour after the ap-
plication, the usual results from an overdose of aconite
internally were exhibited. On examination, no abra-
sions were discovered on face, but the index finger
of right hand had a slight wound. The patient, male,
aged forty-five, of good constitution, was treated with
ammonia and cldoroform, and at the end of forty-eight
hours the symptoms subsided.

C.\Tn.\RTics IN' Albuminuria — Dr. Moore, of Pioches-
ter, X. Y. (Med. and A^urfj. Reporter), read a paper
before the Central Xew York Medical Society, in which
the idea was enforced that albuminuria might remain
as an organic disease for a considerable length of time;
and during that time there was a remedy in sulphate
of magnesia. A case was presented, in which the con-
dition of albuminuria was removed by the cathartic
treatment.

Drs. Benedict and Campbell gave histories of cases
which had been managed according to Dr. Moore's
plan, which afforded relief.

In answer to Dr. Mowris, whether the saline treat-
ment had been successful after scarlet fever. Dr. Moore
replied affirmatively.

Large Pleuritic Effusion Treated by Thirst. — A
case in winch this mode of treatment was pursued
by Dr. Moxon, in Guy's Hospital, is reported in the
Medical Times and Gazett'' of January 6th. At the
commencement of the treatment the right pleural
cavity were filled with liquid.- The drinks of the patient
were Umited to ten fluid ounces per diem, and five
grains each of iodide of potassium and muriate of
ammonia were given three times daily. By the middle
of the third week of treatment dulness on the affected
side had disappeared.

Presence of Bacteria in the Blood during Ery-
sipelas. — Dr. Nepveau reports, in the Gazette Mtdicale
de Paris, four observations, made with a No. immer- '
sion of Ilartnack's make, on blood taken from patients
suffering with this disease, and says: —

1. Bacteria exist in considerable numbers in blood
drawn by puncture from a surface affected with ery-
sipelas; three to five, and sometimes as many as seven,
having been at one time in the field of the microscope.

2. Bacteria exist as well in blood drawn from other

fiorlions of the body than those affected witli erysipe-
atoiis inflaminalion ; they are not so numerous as in
blood drawn from the disea.sed surface, but can almost
always be found in any drop of blood submitted to
examination.

3. In all the ca.ses examined the bacterium punctum
of Ehrenberg was the one observed.

4. They ajipcar t) be present in ca.ses of .so-called
idiopathic as well as in tho.*^ of traumatic erysipelas;
but it remains to be established whether or not this is
constantly the fact.

Xylol is the name of a new hydrocarbon lately in-
troduced to the materia inedica in Germany. Wiien
pure it is colorless and has a faint odor, somewhat like
benzole. Its specific gravity is 80G, an<l its boiling
point 139" C. Xylol, or xylene (Cn IIio), was first
separated from coal naphtha l^y Dr. Hugo Midler, and is
obtained by fractional distillation until a distillate is
obtained of about 140' C. boiling-point; this is mixed
with sulphuric acid, whi<;h dissolves xylol, forming
xylol-sulphiiric acid, which is decompo.sed by dry dis-
tillation, and the xylol thus obtained is further purified
to render its use safe. Its specific action is not, as yet,
very well understood; but it has been administered in
small-pox with such really good results that it bids fair
to be an important remedy. Dr. Zuelzer, Senior Phy-
sician at the Charity Hospital, Berlin, has used it with
" complete success " in the above affection. It is given
in capsules, in doses of from 3 to 5 drops for children,
and 10 to 15 for adults, as often as every one, two, or
three hours. As much as a tea.spoonful has been taken
at one time without injurious effects. — The Pharmaceu-
tical Journal.

Effects of Various Liquors on the Kidneys and
Bladder. — Kraus, of V'ienna, says, speaking of this
subject: '"Sparkling wines are very injurious in dis-
eases of these organs, but not on account of their
carbonic acid, which assist? materially in the elimina-
tion of the phosphates. Champagne not only increases
the secretions, but, in an extraordinary manner, the
phosphates; and the conduct of medical men who ad-
vise its use in cases of calculus cases is very repre-
hensible. His experience absolutely contradicts the
idea of the solvent action of carbonic acid in concre-
tions already formed. Old beer he considers unob-
jectionable ; but new beer is to be avoided, because
the fermenting principle enters the mucous menu
brane, and gives origin to a greater or less degree of
catarrh. English pale-ale is open to the same objec-
tion on account of its richness in alcohol and carbonic
acid; porter, however, if of good quality and age, he
considers to be also unobjectionable.

On the Diagnosis and Treatment of Scrofulous An-
GiN.E. — Dr. E. Isambert, of Paris, writing in The Pr-ac-
titioner of these affections, calls attention to the limited
space devoted to this subject in works on pathology,
and the fact that their distinctive characteristics are
not well appreciated; being frequently confounded with
those of syphilitic, tuberculous, or malignant degenera-
tions of the pharynx and larynx. It is, he says, before
all chronic affections, the almost indolent, and is seldom
attended with hypertrophy of the cervical glands. Stru-
mous catarrhal angina has no very well-defined char-
acter ; the foUiculitis and the amygdalitis with which
it is accompanied being distinguishable from analogous
affections only by considering the general habit and con-
stitution of the patient. Scrofulous ulcerations of the
pharynx constitute, on the contrary, a pathological
type which may be recognized. They are to be met

THE MEDICAL RECORD.

•with, according to their order of frequency : first, on
the posterior surface of tiie pharynx ; next, on the soft
palate and its arches; seldom on the tonsils, on tlie pa-
latal portion of the pharynx, and towards the Eustachian
tube; lastly, towards the epiglottis, the arytenoid emi-
nences, and tlie laryngeal infundibulum. They are al-
most indolent, and are not attended, in the great ma-
jority of cases, by inflammation of the cervical glands.
This localization at the outset, tlie absence of all in-
flammatory and painful phenomena, and of any exten-
sion in the direction of the cervical glands, serve to
distinguish them clearly enough from syphilitic ulcer-
ations, which make their first appearance on the soft
palate, are surrounded by a more extensive circle of
inflammation, and are attended by greater pain and by
inflammation of the cervical glands.

The appearance of the scrofidous ulcers is pretty
similar to that of the slightly eroded syphilitic patches ;
but they do not present opaline or iridescent aspects,
■which in the mucous syphilitic patches form a marked
contrast with the carmine color of the inflamed circle.
The ulcerated patch of scrofula, though irregular and
sinuous like that of syphilis, is more pallid and of a
yellowish color, like that of subcutaneous areolar tissue.
It is but slightly depressed, and presents a rugged
surface, more or less covered with small eminences. It
is surrounded by an inflammatory circle of small ex-
tent and slight thickness, not at all loosened, and
blending in an insensible manner with the ulcerated
surface. Th's border speedily resumes its normal as-
pect under the influence of local treatment. Whilst the
syphihtic patches of the pharynx are well enough de-
fined, and are bathed by abundant and limpid saliva,
scrofulous ulcerations are covered by a very viscid and
adherent muco-purulent or whitish pultaceous secre-
tion. In the graver cases we may observe on the
pharynx a dirty or earthy-gray coating, which covers
all the surface and gives origin to a more or less offen-
sive smell; and yellowish, acuminated pimples, like
small furuncles. These strumous manifestations may
make their appearance without being preceded by other
scrofulous phenomena in the neighborhood.

However, the deformities and morbid adhesions of the
soft palate and its arches, which are sometimes observ-
ed on the first examination of the patient, would show
that previous outbreaks of the disease had taken place.

The iodo-mercurial treatment modifies pharyngeal
syphilitic manifestations in a very short time when
they are not too inveterate. The same mode of treat-
ment makes scrofulous ulcerations w"orse, and if after a
few days of this treatment the symptoms of a case of
pharyngeal ulceration are not improved, a tonic and
anti-scrofulous treatment should be resorted to.

When combated in time, and before the production
of serious injuries to the pharynx, scrofulous ulcerations
are easily cured. At the outset, aineudment takes
place rapidly ; but tlie ulcers, after such changes, close
very slowly, much more slowly, indeed, than syphilitic
ulcers. They are then superseded by white cicatrices
of a pearly aspect, set in small clusters, sometimes
parallel to each other, and at other times radiating in
all directions. As to the adhesions of the soft palate,
it is only by the resort to surgical measures that we
can hope to modify them.

Deafness supervening upon obliteration of the Eus-
tachian tube seems to be beyond the reach of the re-
sources of our art.

The previous history of the patient, and any con-
comitant phenomena, will be of great aid in forming
a diagnosis.

Lupus of the face, or of the nasal fossae, will generally
have preceded pharyngeal lupus.

It is only when phthisis is far advanced, and pul-
monary cavities exist, that we observe ulcerations of
the jiosterior surface of the pharynx, and even then
the ulcers arc small and quite superficial.

Neither herpetism, arthritism, nor catarrhal anjiinai
can produce ulcers which we should be liable to con-
found with pharyngeal scrofula. It is hardly necessary
to refer to pharyngo-laryngeal diphtheritis, whose
course and pathological products are too special and
well known to involve the diagnosis.

Scrofulous lesions present none of the neoplasms
peculiar to cancer, the offensive smell of the latter
aiding, also, in the formation of a diagnosis.

The treatment may be briefly summed up as fol-
lows : —

Absence from mercurial remedies; or, where there
exists a positive mixture of syphilis and scrofula, a
careful employment of that treatment, alternating with
considerable periods of rest, during which the iodide
of potassium or of iron may be employed. Second,
speedy employment of the general treatment of scrof-
ula: cod-liver oil in large doses, iodide of iron, cin-
chona, wine, good food, out-of-door exercise, and
sulphurous baths. Third, persevering employment of
local treatment by means of the laryngeal sjionge,
tincture of iron, either pure or mixed with opium.
The ethereal tincture of iodoform, chloride of zinc, or
concentrated chroinic acid, may be applied to the dis-
eased surface.

Chromic acid is admirably borne by the mucous
membrane of the mouth, pharynx, and even the larynx,
exerting a highly powerful action in oedema of the
glottis, strongly astringing the membrane, and thus
warding off the need for tracheotomy.

Perchloride of iron has been employed, especially in
cases of bleeding ulcers.

Nitrate of silver does not seem to be of much benefit,
unless when applied with the object of hastening the
cicatrization when already in good progress.

Various powders may be blown upon the surfoce,
especially iodoform mixed with lycopodium.

Local douches made with the irrigator may be very
useful, and exert an anodyne action in certain cases.

In respect to atomized fluids, he considers their ef-
fects to be inefficient in such grave lesions.

The most important part of all is to form, as early as
possible, a correct diagnosis, so as to institute a rational
treatment, and avoid hesitation, loss of time, and, above
all, weakening measures which are absolutely contra-
indicated.

Chloride in Place of Bromide of Pot.\ssiu.m. — Dr.
Lander has substituted the chloride for the bromide of
potassium in the treatment of epileptics, with a success
which he declares to be identical. He begins with
smaller doses; but doses of 75 to 150 grains daily have
been borne without inconvenience for months in suc-
cession. He thinks that it is more active, says that it
is one-sixth the price, and not followed by the unpleas-
ant efHects of the bromide. He advances the theory
that the latter is converted in the stomach into the
chloride, and that, for many reasons, it is desirable to
administer it at once in this form.

Compressed Air as a Remedial Agent. — G. von Lie-
big {Archiv f. Klin. Med.) seeks to determine, with a
view to the therapeutics of chronic lung diseases, what
influence is exerted on the respiration by increased or
diminished atmospheric pressure. Respiration at high
altitudes, with low barometric pressure, as is well
known, is exceedingly difficult. This is due to the greater
elastic recoil of the lung tissue from diminished atmos-
pheric counter-pressure. Hence the difficulty of inspira-

THE MEDICAL RECORD.

tion niul the disturbance of circulation. Under increas-
ed barometric pressure, the phenomena are quite the re-
verse ; respiratiou i-i usually decj) and easy, and the pulse
becomes slower. The inlhuiiee of increased or dimin-
ished pressure is not of momentary duration, but per-
sists for some time. Residence at hitrh altitudes ha",
therefore, a tendency to develop the respiratory power,
and streupth generally. From the inlluence of dimin-
ished atmospheric pressure on the lunp?, the advantages
of resi<lonce at high altitudes in cai-es of eniphy.sema
will be apparent. Emphysematous lungs, having lost
their elasticity, and ofl'ering less resistance to the pulmo-
nic circulation, may regain their tone, and respiration be-
come easier. In all casi?sof diminishe<l elasticity of tissue
from any cause, residence at high altitudes under low
barometric pressure is advisable.

DlST.\NCK OF THE ^^ACULA Ll'TEA FHOM THE OpTIC

Disc. — In a recent number of the Cenlralhlntt, Dr. Ed.
Londolt, of Zurich, states that, from careful measure-
ments made by him in upwards of 100 e)'e.s, he has
ascertained that in healthy, or emmetropic eyes, the
distance of the macula lutea from the centre of the
optic papilla, in a horizontal direction, is 3.015 millime-
tres; the former, also, being 0.785 of a millimetre high-
er vertically. The distance is always greater in hyper-
metropic, and less in myopic eyes than is represented
by thes2 figures.

Digitalis a\ AxAniRonisiAC. — M. Gourvat, in the
course of a paper published in the Gciz. Mid. cle Paris,
on the action of digitali.s, says: '"When digitalis, or
digitaline, is administered for some time to a man in full
possession of sexual powers, these become gradually
weakened, the propensities disappear, formation of the
liquor seminis diminishes, and may at last cease alto-
gether. The anaphrodisiac properties of the drug are
the secret of its good effect in spermatorrhoea. With
women, digitalis or digitaline excites strong, regular,
and intermittent uterine contractions, and controls
metrorrhagia ; hence digitalis is employed in producing
abortions. (Tardieu.) It is probable that this drug
acts as an ancphrodisiac in women, inducing, by long-
continued use, impotence and sterility, appearing al>o,
in their cases, to interf(,>re with the development of the
Graafian vesicles ; the propagation of species being thus
doubly retarded.

Freqcenct of Laryngeal Ulceijatioxs in Syphilis
is the subject of a valuable article in the Wiener Med.
Press, from which the following figures are taken : — Out
of 100 post-mortem examinations of patients affected
with secondary syphilis, performed at Prague, Kiihle
saw ulcerations of the larynx 15 times; whilst Alten-
hofer met only 25 cases among 1,200 living patients.
Gerhardtand Roth, on the other hand, found it IS times |
in 54 syphilitic patients — viz., 11 times with 44 second- I
ary patients, and 7 times with 12 tertiary ones. Out i
of 1,000 syphilitic patient?', Lewin found 44 presenting |
an a5"ection of the larynx and more or less hoarseness. ,
Engeftted counted 25 laryngeal cases among 521
patients suffering from syphilis — viz., 14 cases among i
292 men, and 11 ca=e3 in 292 women. Doctor Som- j
merbrodt (the writer of the article) himself collected ;
cases for nine months at the AUerheiligen Ho.spital; i
and, out of 84 patients with constitutional sypliilis, 15 i
presented ulcerations of the larynx in different periods, '
and 14 had catarrlial affections with hypertrophy of |
the mucous membrane. These lesions seem, therefore, I
rather frequent, as already stated by Tiirck in his j
manu.ll. Among 2.38 cases of persons sufi'ering from i
various laryngeal affections, says the author, 45 were
syphihtic. Laryngeal syphilitic symptoms may occur in j

all the stages of the disease. Tiirck observed them in a
I patient who had had primary lesions thirty years he-
lore ; and Krankel has s(>en such ulcerations in a child
I two months old, with whom the first .signs of syphilis
had appeared one month after birth. The earliest
time alter primary lesions ha", in Tiirck's experience,
' been six months; in Somiiierbrodt'.s, five months; and
"j in Lewin's, from two to three month.s. The seat of the
I lesions is indicated in the following table in 92 cases: —

Epiglottis 21 timo.s.

( both,
True vocal cords ■ right 4 ^

/left

( both

False vocal cords < right

(loft

Interior of larynx } '^T'-"""!-' in r
•^ / Anteriorly 10 (

Aryteno-epiglottic folds. . . .

I'pper opening

Right pyriform sinus

Lower portion of the larynx

It will therefore be seen that the vocal cords are the
partsmost frequently attacked, especially the l>/t. This
circumstance sliould be recollected, as, in Rhimer's
experience, tubercular ulcers are mostly situated in the
right, and this peculiarity has a diagnostic value. It is,
in fact, towards the upper part of the larynx that the
syphilitic ulcerations are formed.

Strychnia a Retinal ano Optic Nerve Stlmclus. —
Dr. Juliauj^J. Chisolm, Clinical Prof, of Eye and Ear
Diseases in the Univ. ot' Maryland (Am. Journal of Mecf.
Sciences), advocates the hypodermic use of strychnia in
cases of optic nerve atrophy, and reports cases in which
the effects seemed nearly instantaneous upon the injec-
tion of the fluid under the skin. In nearly every
instance'the patient experienced the brightening of the
light in less than a half minute. Prof. Nagel, of Tiibin-
gen, Germany, injects, in his cases, the temple, near
the seat of the eye disease. As the strychnia has first
to be absorbed, and only acts upon the nerve centres
through the circulation, he sees no advantage in thi^
location over the arm, and hence uses this distant but
more convenient portion of the body. He commences
usually with the one-sixtieih of a grain, which is grad-
ually increased to one-thirtieth, twice a day, in no case
exceeding this last amount. This treatment has been
tried in many cases, doing harm to none, and benefiting
all more or less. In functional disturbances the relief
is prompt; in organic troubles of the retina and optic
nerve results show themselves more slowly. So far,
his experience in the h3'poderniic use of strychnia
enables him to indorse the statement of the wonderful
effects secured by Prof. Nagel, of Tubingen, and he
can recommend to the profession strychnia, hypoder-
mically used, as a most valuable remedy in many cases
of nerve-blindness.

Amputation at the Knee-joint. — Two successful
crises of this amputation are recorded by Dr. G. M.
Staples, Dubuque, Iowa (Am. Journ. Med. Sciences).
In regard to the length of the anterior flap, he states
that the incision extended but a trifle more than an
inch below the tubercle, and, as is seen, the cicatrices
remain in the hollow behind the condyles, with non-
retraction of the patella. If it is a matter of some im-
portance to retain the patella at the end of the .stump,
he asks, may not as short an anterior flap as is practi-
cable and safe, with flexion of the thigh ujion the pelvis
until union is effected, contribute to this result?

THE MEDICAL RECORD.

Ueports Df Societies.

MEDICAL SOCIETY OF THE COUNTY OF
NEW YORK.

Stated Meeting, January 22, 1872.

Dr. Abraham Jacobi, President, in the Chair.

TiTK following physicians wero reported from the Co-
miiia Jilinora as recommended for membership, and, by
vote of the Society, they were admitted, viz. : Alex-
ander Perry, Charles M. FairbroLher, Nicholas L. Camp-
bell, Julius H. Tyndale, Gustavus Treskatis, Herman
Loewenthal, and L. De Forrest Woodruff.

Tlie President announced the death of Dr. Henry
D. Bulkley and of Dr. Alexander N. Gunn. On mo-
tion, Drs. D. C. Carr, D. A. Hedges, and S. W. Roof
were appointed a committee to draft appropriate reso-
lutions in the case of Dr. Gunn. Resolutions on Dr.
Bulkley's death had been adopted at the Special Meeting
which we have already recorded.

DISEASES OF THE PAST YEAR.

The report of the Committee on Diseases was read
by its chairman, as follows : —

The Committee on Diseases has the honor to present
the following report upon the mortality and prevailing
diseases of the past year :

The total mortahty of this city for 1871 amounted to
26,976 — a decrease of 199 from the previous year. It
was equivalent to a death-rate of 28.6 in each thousand
inhabitants.

Zymotic diseases destroyed in the aggregate 8,365
lives — being 31 per cent, ot the total mortality — a slight
increase upon 1870. The most prominent epidemic of
the year was that of small-pox. This disease had pre-
vailed to an unusual extent in 1870, having produced
293 deaths, but it had so subsided in the autumn of
that year, that in the three months ending December
31st, 1870. it occasioned but 12 deaths. In the early
part of January, 1871, it broke out afresh with extra-
ordinary vigor, and rapidly increased during the en-
suing six months. It caused 208 deaths in the first
quarter of the year, and 304 in the second quarter. In
the summer it began slowly to decline, its mortality
being 164 for the quarter, and but 23 for the month of
September. Up to that time the work of vaccination
had been so energetically pursued by the vaccinating
corps of the Health Department, that they had vacci-
nated 100,000 persons in nine months. At the very
time, however, when the prospect was most favorable
for entirely arresting the disease, the Board of Health
was obliged, on account of the failure of its pecuniary
resources, to dispense with its extra inspectors for
some two months. The result was soon apparent in
the extension of the epidemic, as, although only 23
deaths were due to small-pox in October, it occasioned
36 in November, and 70 in December. On November
21th the work of vaccination Avas resumed, but the
disease had acquired too nmch new force to be readily
overcome. Its total mortality for the year amounted to
805, its greatest yearly niortality recorded in this city
during the present century, the next largest number
of deaths, 681, having occurred in 1853. During the
year 2,085 cases were reported to the Bureau of Sani-
tary Inspection. According to these figures its mor-
tality reached 39 per cent. About 47 per cent, of the
deaths were among children of 5 years old or less.
The greatest number of deaths according to locality

were as follows: 17tli Ward, 41; 22d Ward, 37;
2()th Ward, 26; 21st Ward, 23. The Small-Pox Hcs-
j)ital furnished 572. Its severity here during the past
year, although remarkable for New York, was insigni-
ficant as compared with its ravages in many other
places throughout the world. We may simply mention,
for example, among foreign cities the Hague and Lon-
don. In the former (whose inhabitants have always
evinced a peculiar antipathy towards vaccination) the
mortality from small-pox during the first quarter of
1871 was enormous, reaching the extraordinary annual
death late of 48 in the thousand inhabitants — a rate
which would have pioduced in New York 7,500 deaths
from smnll-pox in three months. In London there
were registered during the year 7,876 deaths from
small-pox in a total from all causes of 80,332. In a
single week the fatal cases amounted to 288. The
same death-rate here would have given us 2,300 deaths
instead of 805. The most remarkable epidemic of
small-pox upon this side of the Atlantic has devastated
the city of Philadelfihia. Nearly 2,000 fatal cases were
registered during the past year, of which 1,^12 oc-
curred in the three months ending December 31st.
233 were recorded in a single week.

The next zymotic disease which displayed ati un-
usual activity here during the past year was whooping-
cough. It carried ofi" 465 victims, being the greatest
number of lives destroyed by this disease in any year
of the present century, the next largest number having
been 377 in 1855. 01' the 465 deaths, 196 were males
and 269 females. The large preponderance of females
over males is curious, but, as the death records of
former years show, is quite characteristic of this aftec-
tion. As far as we are aware it is unaccountable.

Remittent fever during the year caused 165 deaths;
intermittent, 110; and typho-malarial, 12. These fe-
vers were never so fatal belore. They prevailed most
extensively in the upper wards of the city.

There is little of interest to record in regard to the
other zymotic afiections. The following statement
presents the mortality of the principal ones for the
yearg 1870 and 1871:

1870. 1871.

Scarlatina 975 791

Measles 298 409

Diphtheria and croup 729 704

Typhus fever 96 65

Typhoid fever 422 239

Diarrhceal diseases 3,956 3,653

The principal feature of the above statement is a
considerable falling ofi' during 1871 in the mortality
from typhus and typhoid fevers and diarrhoeal com-
plaints. 6 deaths were ascribed to cholera ; 6 to re-
lapsing fever; 2 to yellow fever; 142 to sypliilis; 7 to
hydrophobia, and 220 to intemperance. Typhus and
tvphoid fevers Avere most prevalent and fatal in the
l"7th Ward.

The following cases of contagious disease y^ie re-
ported to the Bureau of Sanitary Inspection during the
year :

Typhus fever, 126; typhoid fever, 492; scarlatina,
2,850; relapsing fever, 80; measles, 1,626; diphtheria,
408; small-pox, 2,085.

Constitutional diseases produced 6,263 deaths, about
23 per cent, of the whole, against 6,329 in 1870. Of
these rheumatism caused 103 ; cancer, 339 ; marasmus
and scrofula, 757 ; hydrocephalus and tubercular men-
ingitis, 755; and phthisis pulmonalis, 4,186. The
mortality fiom phthisis was equivalent to 15i per cent,
of the total, and was both positively and relatively
large as compared with that of late years. In 1866 it

THE MEDICAL RECORD.

wa3 equal to 12.2 percent.; in 1867 to 14.4; in 1868
to 13.7; in 1869 to 1:3.3; in 1870 to 14.8; and in
1871 to 15.'). We thiKS [KTceive tliat tliis formidable
disease has been constantly increa.sinf,' in falJilily during
the past six Vi^'.^. About one-(iuait(T of its deatlis
tooi< jdace in "hospitals, and a lar<,'e majority among the
tcnomfnt-liouse population. The migratory character
of that ela.ss of our inhabitants rcndersit almost impo.s-
sible to observe and localize those regional causes
-which may inlluence consumption in this city.

Local diseases, or aflections of special organs, occa-
sioned 9.282 deaths; 34 per cent, of the whole, a
decrease of G17 from the previous year. Of these
there were due to diseases of the nervous system,
2,G77 deaths ; circulatory system, 894 ; respiratory
system, 3,*J48; digestive system, 1,0')2 ; urinary sys-
tem, 1,103; generative system, 54; locomotory and
osseous system, 120 ; and integumentary, 74. Among
these theVe was little worthy of extended mention.
There were 904 deaths from bronchitis, and 1,834 from
pneumonia, against 855 and 1,830 respectively in
the preceding year. Urinary diseases were uncom-
monly fatal, and they appear to have been becoming
more" and more so during the past few years. Thus
the deaths by Bright's disease within four years have
been as follows?, commencing Avith 1808: 534; 557;
787, and 947 — an increase of 77 per cent, during tlie
period mentioned.

Developmental diseases (or those arising from ab-
normal action of the formative, reproductive, or nutri-
tive processes) produced 1,703 deaths, or Oi per cent,
of the whole. 888 were in infants newly bom ; 312
in women ; 333 were due to senile decay ; and 230 to
atrophy and asthenia. These figures were somewhat
in excess over the previous year.

Finally, the deaths from violent causes amounted to
1,303, or 5 per cent, of the whole, against 1,000 in the
jirevious year. " The increase was owing principally to
the July riot, which caused 53 deaths, and the West-
field explosion, 82. 1,070 deaths were ascribed to
accident and negligence ; 05 to homicide; 114 to sui-
cide ; and one was a judicial execution.

Of the total number of deaths, 7,994 occurred among
infants less than one year old ; 10,700 among those
less than two years old ; and 12,970 among children
less than five years old ; the last being 40 per cent. 9f
the total mortality. In 1870, the deaths among such
children were equal to 49 per cent, of the whole; in
1809 to 51 per cent. ; in 1808 to 52i percent. ; and in
1867 to 53 per cent. Altogether, therefore, between
1867 and 1871, there has been a gain among children less
than 5 years old of 13 per cent, upon the total mortality.
There Avere 1,290 deaths among persons 70 years old
and upwards, a gain of 74 upon the previous year. 14
were reputed to have been 100 years old or more, of
whom 3 were males and 11 female?.
KespectfuUy submitted,

Chas. p. Russel, M.D.,
Chairman Com. on Diseases.

C.VNTUOPLASTY IX CONJUNCTIVAL AND CORNKAL AFFEC-
TIONS.

Dr. H. Althof read a paper entitled Clinical Notes
on Diseases of Conjunctiva and Cornea. Its main object
was to call attention to an important element, hitherto
rather neglected in the therapeutics of these affections,
viz. : the diminishing of the pressure of the lids upon
the globe. After a review of the present methods of
treating the more serious forms of conjunctival disorder
— granular lids, diphtheria, blennorrho^a, etc. — all of
them only partially under the control of the physician,
Dr. A. entered more directly upon its special subject.

Thus far, three diflferent procedures had been occa-
sionally followed for the purpose of relieving the ball
of the eye from excessive pressure, viz. : incisions or
excisions of chcmotic conjunctiva; removal of a trian-
gular piece of skin (down to the niu.scle) from the up-
per lid ; and splitting of the outer angle. This last
method undoubtedly suited best, but its goo<l effect
was very transitory, the wound healing up in too short
a time (a couple of hours) to give any i)ermanent re-
lief. If, therefore, a way could hi; found to modify
this remedy so as to make its results la.sting, the thera-
peutic means at our disposal would receive a valuable
addition. This Dr. Althof thought to have been found in
the little operation known under the name of can-
thnplastij. — the splitting of the external commissure
down to the conjunctival .sac, and careful uniting of the
conjunctiva to the outer integument.

The results of this simple procedure had been very
favorable, a large number of cases at present testifying
to its cfliciency. It had rapidly become popular in our
great infirmaries, and wa.s now, after five years' trial,
con.sidered by American oculists a very welcome remedy
in cases v/hich had bafiled the most skilful efi'orts, and
in diseases against which the prevailing treatment was
almost powerless. (jlranular lids and phlyctenular
conjunctivitis and keratitis furni.shed the great majority
of cases in whicii canthoplasty might be employed
with aavantage — to cut olf acute attacks, to diminish
the number of relapses, or prevent them altogether,
and to give other remedies a better chance for effecting
a perfect cure. In genuine diphtheria the doctor
thought it almost inilispensable ; and blennorrhcx>a in
its most acute and destructive forms lost most of its
dangers.

Dr.H. D. Notes agreed Avith Dr. Althof in his high
estimate of the operation of canthoplasty. It had be-
come as much a sine qva non in the treatment of tracho-
ma as had iridectomy in that of glaucoma and diseases
of the iris.

The remarks upon diphtheritic conjunctivitis had
especially interested him, from the fact that he had
within three weeks had in his practice four cases of the
affection, one them very severe, involving the ocular
as well as the palpebral conjunctiva. Up to six months
ago his experience had furnished him Avith but feAV
examples of this disease. Since that time he had had
perhaps a dozen ; and he believed the occurrence of
these cases in such close succession was coincident
Avith an unusual prevalence of scarlet-fcA'er and of
croupous afiections generally.

As to the therapeutics of conjunctival disorders, there
was less need of discovering new means of treatment
than of learning precision in the application of those
now known ; for their number was already bewilder-
ing.

Dr. Agnew's experience had confirmed his belief in
the bold use of canthoplasty. He had been led to
modify the operation by division of the edge of the ex-
ternal tarsal ligament of the upper lid only, as exposed
in the Avound. It Avas the pressure of the tarsal carti-
lage of the upper lid Avhich caused the chief trouble ;
and the incision of skin and mucous membrane alone
would not always make such pressure harmless. He
felt confident that since the introduction of iridectomy
no other addition so important as canthoplasty had
been made to the resources of ophthalmic therapeutics.

Dr. Edward Curtis could testify to the value of the
procedure in phlyctenular conjunctivitis, the prompt-
ness of its eflect seeming at times almost magical. He
related a case, attended Avith great photophobia, cured
by its means in a couple of days.

Dr. E. H. Derby thought the advantage of the ope-

THE MEDICAL RECORD.

ration lay, perhap?, as much in its enabling the surgeon
to reach the retro-tarsal fold with his applications as
in the relief from pressure it afforded. Von Graefe ob-
jected to its employment in diphtheritic conjunctivitis,
from the danger that any wound in such a case might
itself become the seat of diphtheritic deposit.

Dr. ALxnorhad had only seventeen cases of diphthe-
ritic conjunctivitis in five years, up to September last,
though since then he had seen at least twenty. He
would not set his own slight experience against Ton
Graefe's; but although he had always found the
diphtheritic deposit infiltrating the incision, as it does
wounds of other pai-ts, yet he regarded this as of
slight consequence, when compared witii the great ad-
vantage conferred by the operation. By the time the
diphtheritic trouble was cured, the wound was well
healed, and no harm had come of it.

Dr. Koosa had never seen any grave consequences
from the operation as performed by Dr. Althof, though
he had several times seen ectropion of the lower lid
follow, as a result, perhaps, of the incision having been
made not horizon tall}'' outwards, but obliquely down-
wards. He had known, however, one or two instances
of serious injury from the operation, where the dissec-
tion of the conjunctiva was made very thorough, and
carried into the orbital tissue. In one case the eve was
lost.

Four years ago he had had a dispensary case of
phlyctenular keratitis, relieved most remarkably, in
twelve hours, by the operation. He was not aware at
the time that it had been previously performed for this
form of disease.

Dr. Lorixg had been anticipated by the last speaker
in most of what he was about to say. He had ob-
served some half a dozen cases of ectropion due to the
operation, and had several times seen trouble from too
free a dissection of the parts. He thought the division of
the external tarsal ligament, suggested by Dr. Agnew,
should be limited to those cases in which trachoma had
progressed to the extent of converting the inner surface
of the lid into a hard, cicatricial tissue, which by its con-
traction had warped the tarsal cartilnge, increasing its
natural curvature, so as to bring its sharp edge against
the cornea. He had himself formerly employed the
method, originally proposed by Pagenstecher, of dissect-
ing up the conjunctiva so as to make a considerable
flap, the sides of which were so stitched to the skin
near the outer extremity of the horizontal incision as to
convert this into a wound, with its long diameter verti-
cal. But this produced much greater deformity than
the method followed by Dr. Althof; and moreover, as
before remarked, the liberal incision into the orbit was
by no means free from danger. He had seen two in-
stances of severe inflammation from it, one of them be-
ing that referred to by Dr. Roosa, in which the eye was
destroyed. He had therefore abandoned the jilan in
favor of the simple operation recommended in the
paper. In this, as there stated, the stitch at the angle
was the main point upon which success would de-
pend.

Dr. Agnew did not mean to say that he would cut
the tarsal hgament in every case, or that he would ever
cut it in the lower lid. But he would incise it oftener
than recommended by Dr. Loring, on account of the
danger of relapse when this was omitted. Indeed, he
had more than once been obliged to divide the ligament
by a secondary operation, where the ordinary horizon-
tal incision, previously made by another surgeon, had
proved insufficient. There was no difficult dissection
required, and no danger of orbital cellulitis. It usually
sufficed to make the incision through the edge of the
ligament, near its insertion into the periosteum of the

orbital rim. It need not be cut in such simple cases
as those of phlyctenular ophthalmia with photophobia.

CEREBRO-SPI>fAL MENINGITIS.

Dr. RrssEL said that, within three days, seven cases
of cerebro-spinal meningitis had occurred in the city,
three of which had proved fatal. At the suggestion of
Dr. Peters, he read the report of an interesting case
furnished by Dr. C. E. Simmons. The Health Board
were anxious to study the disease, and asked, as a
matter of favor, an early report of any cases which
might be discovered.

The Presidext had seen two cases on the east side
of the city, near Dr. Simmons' case, one of them in the
Hebrew Orphan Asylum at Third avenue and Seventy-
seventh street. He had also, by the invitation of Dr.
Eodenstein, been three times to see the cases under his
charge at the Catholic Protectory in Westchester.
There were some twenty of them ; and five or six had
ended fatally. The speaker pointed to the presence of
stagnant water between Second and Third Avenues, in
the upper part of the town, as connected with the
prevalence of endemic diseases in that neighborhood.

criminal abortion.

On motion of Dr. S. Rogers, the Society

Risolvech That the Medical Society of the Cotmty of
Xew York indorses the Amendment to the Law of 1869,
relative to criminal abortion, proposed by the Xew York
Medico-Legal Society.

Adjourned.

Special Meetiny. January 29, 1872.
Dr. a. Jacobi, President, in the Chair.

OBITCARIES.

The meeting was called to hear memorial notices of
some deceased members, which had been prepared,
under authority of the Comitia Minora, for transmission
to the State Society. Dr. Fordyce Barker, to whom
had been committed the notice of Dr. George T. EUiot.
was unavoidably absent. Dr. Ellsworth Eliot gave an
account of the life and labors of Dr. Wm. B. Bibbins ;
and Dr. Wm. C. Roberts reviewed the career of Dr.
Henry D. Bulkley. The leading points of these memo-
rials have already appeared in our columns. Dr. David
C. Carr recounted the professional and other services
of Dr. Alexander N. Grunn, dwelling especially upon
the assistance he had always been ready to profi'er to
young men. As chairman of the committee on resolu-
tions. Dr. Carr reported the following, which were
adopted : —

^yhereas, It has pleased an aU-^-ise Providence to re-
move from his earthly labors Dr. Alexander X. Guxx,
a beloved associate, and an honored member of the 3Iedi-
cal Society of the County of Xew York ;

Revolted, That in his death all have lost a valued friend
and counsellor. 'and this Society one of its brightest orna-
ments, distinguished alike for his eminent social qualities,
his Christian virtues, and his professional ability.

Rosohed, That while we bow in submission to the di-
-N-ine will, we deplore the loss of an active worker in the
profession to which he was an honor ; of a man who by
his genial, snnshiny nature won not only the hearts of
his patients, but the confidence and esteem of all who
knew him.

Resolved, That a copy of these resolutions be preserved
in the archives of the Society, and also that a copy,
signed by the President and Secretary, be sent to the
family of the deceased.

The meeting adjourned.

THE MEDICAL RECORD.

A Special Meeting called for February 3d, " to con-
Kiik'r, and t.iko suiUiblc action upon, llio bill recently
intro lutrd into the Assembly by Mr. Klaiiuncr, enii-
tli'il. An Act to Protect the People against Quackery and
Crime," was very thinly attended, and adjourned with-
out action.

NEW YORK PATHOLOGICAL SOCIETY.

Stated Meeting, January 10, 1872.

Dr. a. L. Looms, President, in the Cliair.

LATENCY OF STMPTO.MS IN EMPYEMA.

Dr. Lewi.s Smith presented specimens of lunjrs remov-
ed from infants dyinp in the Infant's and Child's Hos-
pital of this Ciiy. The first specimen was taken from
a little patient that died at the age of five months and
twenty-eight days. Although in charge of one of the
best nurses of the institution, nothing unusual was
noticed about the child, except a slight hacking cough
for two or three day.*, and some acceleration of the res-
piration, until it was found dying. On post-mortem
examination tlie right lung was found covered with a
thick sero-fibrinous exudation. The serum, which was
very considerable in amount, was confined altogether in
the meshes of the fibrinous material. The case was of
interest as showing the latency of the symptom.*. There
wns no evidence to the naked eye of pus in the effu-
sion, although it was probable that pus-globules could
be found by the microscope. Dr. Smith was of the
opinion that, in cases of pleurisy among foundlings in an
hospital, pleurisy as a rule degenerated into empyema.

tubercclosis following bronchial catarrh.

The second specimen of lungs was removed from an
infant aged four months and ten days. It had suffered
I'rom cough for seven weeks, during -which time the
physical signs of bronchitis bad been developed. Dur-
ing the last week of life, in addition to the symptoms
referred to, there was an expiratory moan, and this,
with other phenomena, led to the diagnosis of cheesy
pneumonia. Two or three days before death, evidences
of a dilated bronchial tube or a cavity were very dis-
tinctly made out.

On making the post-mortem examination, the left
lung was found healthy, with the exception of a col-
lection of small miliary tubercles. These masses were
also discovered scattered throughout the right lung, in
which latter organ also was found a cavity the size of a
filbert, and nearly filled with cheesy matter. This
cavity was so near the surface that a local pleurltis was
excited, which accounted for the respiratory moan
heard during life. This cavity was lined by a pyogenic
membrane.

In addition, small tubercles, some scarcely visible,
were found in the spleen, liver, and in the coats of the
large intestine. The other organs were healthy, with
the exception of some of the bronchial and mesenteric
glands, which were slightly enlarged and contained
cheesy deposits. The interest in this case centred in
the regular gradation of pathological changes, commenc-
ing in ordinary bronchitis and ending in miliary tuber-
culosis.

The third specimen was removed from a child that
died at the age of three months. The patient was sup-
po.sed to be doing well until eighteen hours before his
death, when he began to breathe rapidly, the pulse
became accelerated, the temperature elevated, and
death finally occurred as the result of what was sup-
posed to be capillary bronchitis.

At the autopsy, both lungs were found studded with
tubercles in process of formation, and around them
were to be teen zones of vascular injection. Small
tubercles were also found in spleen, liver, ami in other
organs. The mc.M;ntcric glands appeared to be healthy,
but the bronchial glands had ui;dergone cheesy de-
generation.

In answer to a question from Dr. Loomis, he stated
that in his opinion empyema was more apt to follow
pleurisy in foundlings tiian in adults.

Dr. Loomis remarked that he had seen cases of acute
pleuri.sy in adults, that were cases of empyema from the
bcfiinning, and he had also .seen cases of empyema the
natural residt, apparently, of ordinary pleun.sy in a pa-
tient otherwise in good condition.

The Society then went into Executive Session.

Stated Meeting, Jan. 24, 1872.
Dr. a. L. Loomis, President, in the Chair.

uterine tumors and ascites. A NOVEL METHOD OF

TAPPING.

Dr. Caro presented a specimen of the above with

the following remarks: Mrs. H , thirty-nine

years old, married twenty years, had no children. She
complained, November, 18G4, of dy.smenorrhoea. On ex-
amination, a polypus the size of a cherry was found
protruding from the internal os uteri. I evulsed it
with a pair of long forceps, and cauterized the pedicle
with nitrate of silver. No hemorrhage followed ; men-
struation returned regularly until September, 18G8,
when it disappeared. Supposing herself pregnant,
she did not inform me of the loss of her catamenia un-
til November of the same year. Examining the
uterus, I found she was mistaken as to pregnancy,
although her breasts gave evident signs of it. I advised
no interference, but to wait for further developments.
January 20th, 1869, called in consultation the late
Prof 0. T. Elliott. We concluded she was not preg-
nant, but could not decide upon what -prevented her
monthly returns, or caused the abdominal enlargement,
unless it was simple tympanitis. Nourishing diet was
prescribed, and an occasional dose of cream tartar and
Epsom salts to regulate the bowels. In February men-
struation returned, and continued regular until death ;
but the abdominal enlargement continued, giving signs
of ascites. June 4th, 1869, had her examined in the
presence of other physicians, at Dr. Emmet's hospital.
As previously done, sound was passed into the womb,
two and a half inches. Arrived at the conclusion that
she had a fibrous tumor adhering to the womb, and
ascites produced by subacute peritonitis. Elaterium
and cream tartar were prescribed, also tapping.

June 30th, in presence of Prof O. T. Elliott, I per-
formed paracentesis, selecting the median line between
umbilicus and pubes; — sixteen quarts of fluid were
drawn. Microscopical analysis of the fluid was made
by Dr. Stephen Rogers, who reports : " The fluid
was highl}-- albuminous, contained many blood-globules,
and amorphous colored constituents in the form of
various-sized dark-brownish masses. There are also a
few granular, cell-like objects, containing one or more
nuclei, in fact exudation corpuscles." Suspecting them
to proceed from a cystic cavity, I changed my treat-
ment and prescribed: —

Spiritus mindereri § iv.

Acidum aceticum 3j.

Tr. ferri ehloridi 3 ij.

A tablespoon ful three times a day.

THE Medical record.

This remedy increased the flow of urine, but did not
arrest the ascites. She was tapped every second
month as follows : August 30th, 1809, second tappinj?,
twenty-one quarts were drawn ; October 26th, 18G9,
third tappiiip-, twenty-three quarts were drawn; Janu-
ary 4th, 1S70, fourth tapping, twenty-five quarts were
drawn; March 19th, 1870, fifth tapping, twenty-four
quarls w^ere drawn ; May 11th, 1870, sixth tapping,
twenty-eight quarts were drawn ; July 9th, 1870,
seventh tapping, twenty-eight quarts were drawn ;
August 29tl), 1870, eighth tapping, twenty-seven quarts
were drawn ; November 1st, 187U,ninth tapping, thirty-
one quarts were drawn; December 15th, 1870, tenth
tapping, thirty-two quarts were drawn ; February 10th,
1871, eleventh tapping, thirty-six quarts were drawn;
March 30th, 1871, twelfth tapping, at Emmet's hospi-
tal, thirty-six quarts were drawn; May 27th, 1871,
thirteenth tapping, twenty-six quarts were drawn.

Left canula permanentl}', with a iaucet, so she might
draw the fluid herself, but during tint night it came
out. July 11th, 1871, fourteenth tapping, twenty-
eight quarts v-^ere drawn, and canula lell in situ until
December 10th, when it was removed to be repaired.
After removal the flow of fluid stopped, and abdominal
pains commenced. January 10th, 1872, she died of
peritonitis. On post-mortem examination, a vast
amount of fatty degeneration was found around the
womb ; to the left fundus of the uterus, two ovarian
cysts, about the size of a pine-apple, adhering to one
another; and above them a tumor of calcareous nature,
adhering firmly to the diaphragm, the abdominal vaults
firmly adhering to the cysts and tumor, and the peri-
ton£Eum to the intestines infiltrated with a serous fluid.

The fluid from the cysts and the tumor were ex-
amined by Dr. S. Rogers, who reports as follows :
" The hard masses found in the substance of the speci-
men are composed of irregularly spherical bodies, car-
bonate of lime, adhering to each other very firn)h^ It
is henc-i ca^.careous, not osseous. The tumor is a some-
what degenerate fibroid growth. The fluid from an
adjacent cyst is of a brownish color, and abounds in
crystals of cholcsterine, fatty granules, and globules.
It is therefore not improbable that the cyst represents
a degenerate and liquefied fibroid tumor."

The amount of fluid by paracentesis was 381 quarts,
and drawing at an average one pint a day from July
11 to December 10th, was seventy-six quarts, total 457
quarts. Of the mixture, as above prescribed, 244 oz.
was used.

Dr. Hart referred to the possibiliiy of the tumor being
cancerous, as, according to Prof. Thoma^^, the persistent
accumulation of serum in the abdominal cavity was
almost pathognom.onic of that disease.

Dr. Loomis remembered one case where tapping was
performed twenty-eight times. The patient, a lady,
had been tapped twenty times by the late Prof Simp-
son, of Edinburgh. The intervals of tapping grew
longer, and the last operation was performed as long
ago as four years.

ANEURISM AND ITS RELATION TO SYPHILIS.

Dr. Flint exhibited a specimen of aneurism of the
abdominal aorta. The history of the case was very in-
complete, the patient being received in the hospital
only a few houis before his death, and then in a state
of almost complete exhaustion. It Avas ascertained,
however, that he had had syphilis fourteen years be-
fore, followed by certain constitutional symptoms, af-
fection of the throat, eruptions, etc. During last sum-
mer he had complained of pain in the back and abdo-
men. After his admission he rallied somewhat on tne
use of stimulants, so that the facts above narrated were

obtained. The hou.se physician ascertained the pre-
sence of a tumor which he found to be pulsating, but he
discovered neither thrill nor murmur. Shortly after
his temporary improvement he raised up in bed, when
he complained of feeling faint, was laid back, and ex-
pired almost immediately.

The abdominal aorta, just above the renal arteries,
showed a large circular opening, perhaps an inch and a
half in diameter, which communicated with an aneuris-
mal sac the size of a small orange. There was a per-
foration in the sac large enough to admit the end of the
little finger. There was some blood infiltrated in the
areolar tissue beneath the artery, and the peritoneal
cavity contained a large quantity of blood. The speci-
men was of no particular interest except the fact that
it occurred in a patient who had syphilis, and that, in all
probability, there was a certain amount of hemorrhage
from rupture before he was admitted into the hospital,
and that the hemorrhage was arrested by temporary
coagulation. The internal coat of the artery was lined
with atheromatous deposits. The patient was 37 years
of age.

SYPHILIS AND VALVULAR DISEASE.

Dr. Janeway believed that syphilis was not only a
very common cause of aneurism, but a'so of valvular
disease. He had met with two cases of thickening of
the valves which could be explained in no other way.

Dr. Flint had not had his attention drawn particu-
larly to syphilis as a cause of valvular disease, but
thought that it might explain many of the cases of the
latter le.sion, in which none of the usual causes were
made out.

Dr. Mason had seen several cases of aneurism which
appeared to be the direct result of constitutional syphi-
lis. He referred to one case in point, occurring in a
man aged 33.

Dr. Loomis alluded to a long list of cases published
within the last two years in the Lancet, in which all
under the age of forty gave a syphilitic history.

Dr. Rogers was reminded of a case presented to the
Society ten years ago, of very extensive aortic disease,
in a young man 28 years of age, who had contracted
syphilis only eighteen months before his death. The
patient eventually died of extensive aortic disease. In
that case no other cause for the arterial and cardiac le-
sions was assigned than syphilis.

PERIPHERAL PLACENTITIS.

Dr. Rogers presented a foetus, with the following re-
marks : — About a month ago I presented a specimen of
placental disease that has been ranked as comparatively
rare. Its history was. that a lady, at about the begin-
ning of the fifth month, or a Httle after, began to sutler
from the escape of blood from the vagina, with uterine
contractions which were regarded, by every one who
saw her, as threatening abortion. The bloody charac-
ter of the discharge subsided little by little; but at va-
rious intervals she had very large discharges of colored
fluid, in such abundance as to saturate six or eight nap-
kins in a single evening. In that case there were also,
within a period of twomouths, after frequent threaten-
ings of abortion, contractions of the uterus, with the es-
cape of more or less bloody fluid. So marked were
these contractions that the lady herself would call at-
tention to it. There was a good deal of interest at-
tached to the case, and some of the leading obstetri-
cians were called in to see it. It was regarded as a case
of cystic degeneration of the ovum. However, from
time' to time, besides bloody fluid there Avas a discharge
of such a material as is seen in this vial. [A vial ex-
hibited, containing blood-stained shreddy material,

THE MEDICAL Re);ORD.

lloatinp in a bloody fluid.] Sometimes a plug of this
material, as large as the little finger, would come away.
Notwitlistaiidinjr the ca^e was (liaprnoslicatrtl as a cys-
tic degeiuration of the chorion, tliere w.is evidently a
live fcetus in the womb. It went on growing', and
continued active up to the last. It was early in the
fourtli iiioiilh that the t^ymploms commenced. Towards
the end of the fifth month labor came on, and when I
arrived I found the caput succedaneum protnidinp, and
soon delivered the woman of a child which breathed an
hour after birth.

The placenta was found diseased ; its whole periphe-
ry was blackened and slircddy. In some portions of the
organ it had gone on to an extent of llirec-fourths to
an indi in dc|)th. It was a striking example of a dis-
ease of the whole peripliery of the placenta. It struck
me at onre as a case of peripheral disease the like of
which I had never .seen. I recited the appearances to
Dr. Noepgerath, and he made the remark that the case
was one of peripheral placentitis.

I present another specimen very similar to the one
just described. This case had advanced to the sixth
month. The mother received a sliock, caused by one of
her children running again&t her abdomen. Scon after
she was taken ■with a discharge of blood from tlie vagi-
na. There were no uterine contractions nor pain. All
that was noticed for a few days was a little bloody dis-
charge, when it became less blood}'. But at vari('US
intervals she would have these large discharges blood-
stained, which would saturate half a dozen napkins at a
time. She went on for two whole months, and when
labor set in the child was evidently alive. The presen-
tation was a breech one, and the head of the child was
detained so long that life was destroyed — at least
such was the belief of the attendant. At all events,
the child was alive two hours before labor set in. The
placenta presentij a little different appearance from
the first; it is much smaller, and its whole structure is
lobulated. When this specimen was first "brought to
me I found evidences over more tlian three-fourths of
its periphery of this same kind of inflammation — peri-
pheral placentitis. At two or three points there were
little clots of blood, but the marked feature was a layer
of fibrinous material — thicker at some places than
others — all aroimd the edge of the placenta. Dr. Jacobi
was disposed to look upon the fibrinous clots as the
residue of the hemorrhages. That may be so, but in the
case which I presented, during one period of more than
two weeks, there was scarcely any hemorrhage; it was
almost pure water, and on some occasions there were
those extra fibrinous clot«, and during that period
she had more discharge of those fibrinous shreds
than she had immediately after, or about the time
when there had been mo.st hemorrhage. They ran
through a period of more than a month.

I have since asked some questions of persons versed
in the literature of the subject with reference to the
frequency of this kind of placental disease, and I am
precisely where I was a month ago, viz., that there is
not very much written or said about it in that form.
Dr. Noeggerath said then that the only paper written on
this suViject was by Braun, of Vienna, several years
ago. The first case, presented a month ago, has had no
untoward symf.tom, and is perfectly well. The first
.ady was delivered two years ago of a child that re-
mained in utero a month after it died. The child was
Killed at the eighth month by metro-peritonitis, which
interrupted the foetal circulation. The mother in a
measure recovered, and went on to full term. She had
metritis after delivery, and a little pelvic cellulitis.
She therefore had the antecedent of uterine inflamma-
tion estabhshed, which this person has not.

Dr. Jankwat thought that there might have been
a partial deiachmoiitof the placenta in this la.st case, at-
tended first with a disiharg'Mjf bl()0<i, tiicn serum with
the shreddy material — the re^ulL of the breaking down
of the dot.

Dr. IlouEKS thought that this was the case in both
instances.

FUACTURE OF SKCTIX.

Dii. J ANEW A V presented a specimen of fracture of
skull, with the following history : —

The patient from whom this .^^pecimcn was taken was
a female lorly years of age, who, as subsequently to
examination, was found to have been struck in the
head by a hatchet, .some five years before. She was
admitted to hospital tlie day before death, para-
lyzed on the right side, and unable to give any
account of herself. Later it was found that she had
fallen down-stairs. She died with .symptoms of com-
pression of brain. Sfrvice of Dr. Smith.

Autopsy, Dec. 'J.3, 1871.

Exterior. — Large amount of adipo.«e tissue. A .slight
white cicatrix over the upper and middle portion of the
right parietal bone. Some bruises on forearms.

Scalp. — Extravasated blood in the tissues of left side
posterior part, and a lacerated wound behind ear.

Skull. — A fissure on left side, starting from centre of
occipital bone, passes forwards through line of lamb-
doidal suture, petrous portion of temporal bone, into
larger wing of sphenoid bone, as far as foramen rotun-
dum. The middle meningeal shows a small lacerated
opening in its main branch.

A large clot exists between dura mater and bone,
principally situated over posterior lobe of cerebrum,
outer and lower part of loft side.

On the right side of skull, corresponding to the line of
cicatrix above mentioned, a depression of outer table of
skull is found, oval in shape, and situated diagonally
between coronal and sagittal sutures. The border of the
depression is rounded, smooth, and it and the depressed
portion are lined by thickened periosteum. The depth
of depression is 3-20 of an inch ; length 1 inch. On
the inner side of skull, at this point, the internal table
forms a sort of wedge-shaped projection, 1-5 of an inch
high, and having a line of fracture running along the
ridge or apex. This latter portion is still quite sharp.
The dura mater at this point presents a similar shaped
depression, but no other lesion.

Brain. — There is a depression of brain on the right
side, corresponding to site of depressed fracture, but
without other lesion. A vein going to longitudinal
sinus is pressed on, and the result has been a varicose
condition on the distal side. On the anterior portion
of brain, right side, the convolutions are flattened, sulci
somewhat obliterated, and subarachnoid serum absent.
The left side showed a severe contusion of lower part
of left middle lobe, and extending across fissure of
Sylvius so as to implicate the extremit}' of the third
frontal convolution. The tissue at this point is softened
to a pulpy state,'and ecchymotic cervical convolutions of
frontal lobe were in a similar state. The brain-tissue of
posterior lobe presented a depression corresponding to
the site of clot of blood between dura mater and brain.
The ventricles contained the usual amount of serum,
slightly blood-stained.

The other viscera, with the exception of kidneys,
were normal.

These latter presented a granular surface and atro-
phied cortex, and were smaller than usual.

The depression in this case led to the question of the
propriety of an operation. \

But Dr. Stephen Smith, the visiting surgeon, decided

THE MEDICAL RECORD.

against the propriety, because of the marks of injury
behind left ear and of the paral3'sis on the right side.
I have thouglit that the coincidence of tlie two lesions
would be of some interest.

PSEUDO-TRACIIEO-BRONCIIITIS.

Dr. Lewis Smith presented a specimen of p.'eudo-
tracheo-bronchitis, which was removed from a Avoman
twenty-four years of nge. .She was admitted into the
lying-in wards connected with the Nursery and Cliild's
Hospital in Nov. last. Nothing unusual was noticed
in her condition until the third of the present month,
when the house-physician, Dr. Eeckwith, found her
urine albuminous. Jan. 9 she called his attention to
her throat, but on examination nothing worthy of note
was discovered. On the third day after she began to
sufler considerably from d3^spnoea, which condition in-
creased so mucli in severity that by the thirteenth she
was unable to lie in bed. At the same time a dry
cough developed, and the physical signs of oedema of
the lungs showed themselves. Death occurred two days
after. As no other signs showed themselves, it was
thought probable that death had been due either to
oedema of the lungs or to oedema glottidis.

On post-mortem examination, the following day, a
pseudo-membrane covering the lower part of the epi-
glottis, trachea, and bronchial tubes to their third divi-
sion was discovered ; the membrane growing thinner
as it went downwards. The underlying mucous mem-
brane was intensely injected.

The fauces had been inspected every day until with-
in twenty-four hours of her death, and no appearance
of membrane was noted. On careful examination at
the autopsy it Avas discovered that the membrane had
just begun to make its appearance upon the pharyn-
geal surface of the epiglottis, Avhich condition might
have been observed had an examination of the parts
been made within ten or twelve hours of death. There
were found large clots in all the heart cavities, which
Avere much dilated. Those in the right ventricle extend-
ed through the pulmonary artery to the lungs. The
appearance of the membrane, its symptomatology, and
the surrounding circumstances of the patient seemed to
justify the opinion that this ease was one of true croup
rather than of diphtheria, which fact made the speci-
men interesting, occurring, as it did, in a person of that
age.

Dr. Janeaa'ay referred to a case illustrating the rapid-
ity Avith Avhich oedema of the lungs can shoAV itself in
cases of arrest of respiration. The patient Avas choked
while eating his dinner in one of the wards of Belle-
vue ; relief was obtained by immediate tracheotomy, and
nothing was found in the air-passages, as far as any ex-
ploration could be made. In five minutes from the
time of the accident the patient died of secondary oede-
ma of the lungs.

Dr. Loomis presented a specimen, rather as a matter
of curiosity than otherAvise. The history of the patient
from AA^hom it was removed Avas very incomplete. She
Avas forty years of age, and Avas admitted into Belle-
vue on the llth of Dec. in a very exhausted condition.
About a AA'eek before admission she suffered from in-
tense pain in the right hypogastric region, which
extended into the iliac region. About tAvo days after
this pain made its appearance she began to vornit, and
had diarrhoea. The vomiting and diarrhoea continued up
to the time of her admission. She had had a similar
attack about a year before, from Avhich she recovered
after a lingering illness. The hou-se-physician noticed
that there Avas a verj- offensive discharge from her va-
gina, and in making an examination he found that the
finger could not enter more than an inch, Avhen it Avas

arrested by a mass of roughened tissue. lie regarded
it as a case of cancer, and did not make a very tho-
rough investigation of the exact condition of tilings at
that time. Her abdomen Avas quite tympanitic, and
soon after admission ?he sank into collapse.

At the autopsy there Avere evidences of extensive
peritonitis. In the right side of pelvic cavity there Avas
an increased amount of connective tissue, and the
broad ligament Avas thickened and hardened. There
was an abscess at the rim of the pelvis, and it seemed
as though another had broken into the pelvic cavity.
All the tissues in the neighborhood had been thickened
and indurated ; the bladder Avas pressed forward, and
rectum flattened and adherent to the posterior Avail of
the uterus. Tlic uterus itself seemed somcAvhat en-
larged.

The interesting point was that on opening the
vagina a spool, an inch and a half in lengtli and three-
quarters of an inch in thickness, Avas found in its cav-
ity. Through the canal of this spool Avas a thread,
knotted at its upper end. The loAver portion of the
tube Avas covered Avith calcareous incrustations. This
foreign body, Avhich had doubtless remained in its posi-
tion for a considerable time, had ulcerated into the
bladder, and had given rise to all the pathological
changes in the pelvic cavity, ending secondarily in the
peritonitis Avhich caused death.

The Society then went into Executive Session.

Cotres^JontrciTCf.

LESSONS FROM SANDRINGHAM.

To THE Editor of the Medical Record.

Sir : — It is not often that the management of any
medical case assumes the proportions of a public event.
When it does, besides the interest of the masses, and the
reputation of the attending physicians, there are at stake
the general standing of the profession, and the rank
then assignable to physic among the phj'sical sciences.
The case of the Prince of Wales was of this class.

In order to avoid even the appearance of being in-
fluenced by popular and contradictory clamors in a
question whose scientific interest is hardly second to
the political, Ave have postponed the expression of some
of the remarks suggested by tlie character of the bulle-
tins of the physicians Avho attended to this memorable
case. But now that the public has rendered its ordi-
nary verdict: "All is Avell that ends Avell," let us say
that all that came from Sandringham Avas not as Avell
as it could have been for the eminent physicians them-
selves, nor for the profession at large, nor for the fair
name and promotion of medical science.

We particularly refer to the sanitary bulletins as not
representing accurately the condition of the patient, as
virtually and Avrongfully ignoring the new means of
clinical description Avhose A'eracity cannot be impugned,
and as made up of the flabby expressions of alternate
fears and hopes.

We have simply heard that the Prince Avas better,
Avorse, recovering, sinking, rallying, convalescing, re-
lapsing, and finally recovering. For many Aveeks this
was all the ncAvs given to an attentive world. The
prognosis Avas as wavering, and seemingly as uncertain,
as it might have been half a century ago, before ther-
mometry or sphygmography Avas dreamt of Naturallj',
these bulletins, very much resembling those issued
from Metz Avhen France had the misfortune of not
losing Louis XV., alias le bien-aime, were soon dis-

THE MEDICAL RECORD.

trusted, nml nccii«cd of cxapgeration, oven of false-
hood ; fttnl openly said to be calculated in view of
manufacturiu!:!; loyalism, or for the vile object of fostering
gambling conibinations.

That men like Dra. Jenner, Gull, and Lowe, whose
scientific reputation is so high, could have exposed
themselves, and tlic medical profession as a body,
to such inipos-ibic imputations, shows that there was
n serious misconception of their duties to the sceince
of mediiine, and tliat at a time when they had the
whole civiliztMl world for an audience.

It seems that tiie cause of their mistake was the idea
that the majesty of the subject precluded the ]>ossibility
of nublishinn the true clinical record of his sicknes.s, as
if ine disease sliould behave differently in a Prince than
in a simple hospital patient. This courtly idea offers
the only extenuation for tiie unscientific character of
these bulletin?, but is far from finding its justification
even in courtly habits and traditions. For these tra-
ditions and habits have always been, in case of sick-
ness of a Queen. King, or Crown -Prince, to issue bul-
letins as complete as the science of the time could
afford, and to keep the royal patient constantly in view
of .some of the high officers of State.

And why that publicity of sickness and death;
why cannot a king agonize quietly ; Avhy must peoples
prey upon his decomposing form by minute reports
and by de visii proxies ? Evidently because a prince
— whatever could otherwise be his individual worth —
is a cipher, wliose social value is borrowed from the
millions standing by him, millions who have never
been denied the right to know what becomes of the
zero.

Therefore we do not hesitate to affirm that, if the
physicians of the Prince of Wales in issuing their
bulletins hare literally conformed them.selves to courtly
traditions, in avoiding or neglecting to stamp these
bulletins with the seal of modern positivism, they have
forfeited the confidence of the English nation; they
have left the door of their council-chamber open to
imtrue but deserved .suspicions; they have neglected a
solemn occasion of impressing the people with the
precision of the methods of observation which have
been substituted for guessing at the bedside ; and
thereby these eminent physicians have, in no small
degree, lowered, or at least prevented the legitimate
rise of, the standard of physic in public estimation.

On the contrary, let us for an instant suppose that
these eminent men. improving the opportunity actu-
ally offered to them by the tradition of all the courts
of Europe, would have clothed their bulletins in the
scientific form adopted by the medical institutions of
London, Pari?, Vienna, Berlin. New York ; these daily
or hourly reports would have been written in a few
figures, and summed up every septenary. They could
also have been accompanied by a few commentaries, such
as escape from the lips of a medical man looking at
the table of vital signs appended to the bed of an ordi-
nary subject of typhoid fever.

In the supposition tliat these popular and progres-
sive views had prevailed in the judgment of the physi-
cians in charge at Sandringham, the world would have
assisted to a novel and dramatic spectacle. We do not
mean the spectacle of the pitiable youth slowly eaten
up, then let go by the ulceration of his Peyer's
glands — we mean the narration, by telegrams, of the
phases of an almost typical case of complicated typhoid
fever. Never before would nations have listened to
such a tale, rna'nly told in advance, like a prophecy,
by the thermometer ; never such interest would have
been attached to predictions of better or worse, fore-
shadowed on the stem of the instrument, and to the

degrees of vitality infused in the patient by tonics or
food, and written in tlie pulse-wave of the sphygmo-
graj)h. Such a medical problem would never before
have been solved to a larger or more interested
audience: no better opportunity <'ould have been
found to prove to the civilized world huw much of a
science medicine has cume to be.

If this mode of bulletins had been adopted — and we
firmly believe that Aitken, Sydney Ringer, Wunder-
lich, or Jaccoud would have carried it <jut — what an
impulse would that lesson on positive diagnosis have
given to the profession ; how higher would physio have
instantly ranked in the c=timation of the public ; and,
to speak but once like courtiers, what a chance the
Prince would not have lost of being as useful and cele-
brated for his sickness as his father was for his good-
ness ! These are some of the iessons we had, and had
not, from Sandringham. E. S.

New York, Feb. 20, \b~-i.

CLAY-DRESSIXGS FOR VARIOLA.

To THE Editor of the Medical Record.

Sir — During the recent epidemic I used clay-dressings
for two pretty decided cases of confluent small-pox.
Both patients were young women. One, a married lady,
a;t. 23 /delivered on the second day of a six months' foe-
tus), made a fair recovery, took cold after getting up,
and in a few days died suddenly of empyema and peri-
carditis; diagnosis confirmed by autopsy. Tiie other,
single, ajt. 21, had the disease with great violence, re-
covered rapidly, and is now well. In each case I dust-
est finely-sifted pipe-clay over the face as soon as the
pustules became fairly developed. This formed imme-
diately a clean, dry, wholesome scab; abolished the in-
tolerable itching and burning ; served apparently as a
good absorbent of infectious material; and scaled off
during convalescence, leaving underneath a sofr, natural
integument.

There was no disfigurement in either case.

E. S. BC.NKER, M.D.

Brookltk, Fob. 12, 1ST2.

MEMBRANOUS CAST OF VAGINA.

To THE Editor of the Medical IIecord.

In your issue of January 15th, p. 512, appears a very
interesting communication fio:n Dr. G. H. Miner, in
which he describes a membranous cast of the vagina,
expelled by one of hi-; patients. I have never seen a
like example, but if Dr. Miner will read the last page
of the ninth chapter of Montgomery' '" On the Signs
and Symptoms of Pregnancy," I think he will find a
very satisfactory explanation of these curious forma-
tions.

Dr. Montjromery attributes them to the coagulation
and condensation of the epitlielium and mucus of the
vagina by injections of nitrate of silver, and Dr. Miner
had used in his case "a very strong solution — 3j. to
3J. of water."

Wm. Goodell, M.D.

I'RESTOS IlETREAT, Philadelphia.

The Darwinian Thkory. — The ]Viener ^fed. Pj-esse
contains a singular argument in favor of the doctrine of
Darwin, that man has developed from an ape. It is
found in Brazil that the ape is equally susceptible with
man to the ravages of yellow-fever, all other animals
enjoying an immunity from the attacks of this disease.

THE MEDICAL RECORD.

©bituarji.

PROF. CHARLES A. LEE, M.D..

I'EEKSKILL, N. Y.

Our old friend, Prof. Charles A. Lee, is no more. lie
died February 14, 1872, at his home in Peekskill. It
is safe to say tliat no one medical man has contributed
more largely to the literature of his profession than
he has. From early life to an advanced ai^e his pen
has been busy in many departments of the healing
art, and by dint of great industry and appHcation he
soon won for himself the very enviable reputation of a
learned writer. Nor did his powers of composition, or
his ability to think deeply, forsake him in the latter days
of his career. It would be impossible to give more
than an epitome of his literary labors, extending as they
did over nearly half a century. He has edited Lees
Physiology, a work formerly in extensive use in our
schools ; Elements of Geology, Copeland's Medical Dic-
tionary, Pereira on Food and Diet, and many other
works. He was for many years Professor in the New
York University, the Bowdoin Medical College, Berk-
shire Medical Scliool, the Medical School at Woodstock,
Vt., Greneva Medical College, and was also one of the
founders of the Buflalo Medical School. In connection
with the late Dr. Stewart, of this city, he, many years
since, estabhshed the Northern Dispensary, an institu-
tion Avhich has been of great and incalculable benefit to
the poor of New York. He was for many years editor
of the New York Journcd of Medicine. During the
years 18G0 and 18G1 he made an extensive tour of
Europe for the purpose of ascertaining the accepted
methods of treating the insane. He visited all the noted
Insane Asylums abroad, and gave the results of his la-
bors in an extended series of carefully written letters to
the American Medical Times. From that time he became
much interested in the study of psychology, and was
soon enabled by his writings in the various periodicals
of the country to establish the reputation of an autho-
rity on mental diseases. He was not unfrequently
called upon as an expert to testify upon important crim-
inal cases, and his opinions, often elaborately Avritten,
received the warm commendations of the presiding
judges. He has been a frequent and esteemed contri-
butor to tlie columus of this journal, and has always
been ready and willing to give us that counsel which
was the offspring of a sound judgment and of a consci-
entious regard for strict justice.

During the recent war his services were tendered to
the Sanitary Commissioner, and as an inspector he ren-
dered invaluable aiJ. If we were to enumerate his la-
bors as member of the many Committees of the Ame-
rican Medical Association of the State and pharmaceu-
tical societies, w^e might fill pages; suffice it to say,
however, that in the capacity of a worker in such avo-
cations he was untiringly devoted to the best interests
of his profession and to the surest means of advancing
our art. in. the cause of medical education he was a
faithful exponent of the views of the rising generation,
and was never backward in expressing his opinion in
an unmistakaljly radical manner. During the past two
years he has been compelled, on account of declining
health, to withdraw himself somewhat from the occu-
pations he so dearly loved. Among other things he
resigned his professorship at the Buffalo Medical School,
of which, as has been before stated, he was one of the
founders.

He was a zealous churchman, and his spare time was
devoted, in a quiet and unostentatious manner, to the

support of Christianity. He lived the life of a consistent
Christian, and in his walk and conversation, from his
youth until the close of his earthly career, he proved the
excellence of his spiritual choice. As a man he was
upright in all his dealings, radical in his views, and an
uncompromising enemy to fraud in any shape. Quiet
in his demeanor, affable in manner, and earnest in spirit,
he won for himself a large number of friends, who will
unite with us in dropping the tear of affection upon his
honored grave.

ARMY NEWS.

Official List of Changes of Stations and Duties of Offi-
cers of the' Me'lical Department, U. S. Army, from
February 5, 1872, to February 18, 1872, inclusive.

Mills, Madison, Surgeon. — By S. 0. 30, War De-
partment, A. G. O., February 5, 1872, granted leave of
absence for sixty days.

Frantz, Jno. H., Surgeon.— By S. 0. 38, War De-
partment, A. Gr. 0., February 14, 1872, to report to the
Commanding General, Department of the South, for
assignment to duty.

Mackin, Ciias., Jr., Assistant Surgeon. — By S. 0. 33,
War Department, A. G. 0., February 8, 1«72, to re-
port to the Commanding General. Department of the
South, for assignment to duty.

HoFF, Alexander H., Assistant Surgeon. — By S. O.
31, War Department, A. G. O., February 6, 1872,
as^igned to duty at Fort Columbus, N. Y. Harbor.

Kimball, J. P., Assistant Surgeon. — By S. 0. 33,
War Department, A. G. 0., February 8, 1872, assigned
to temporary duty at Fort Columbus, N. Y. Harbor, to
accompany the first detachment of recruits to New
Orleans, La., and, on arrival, report to the Command-
ing Officer, Department of the Gulf, for assignment to
duty.

LoRiNG, L. Y., As-istant Surgeon.— By S. 0. 18,
Department of the Mo., February 2, 1872, to proceed
to ifort Leavenworth, Ks., and report to the Com-
manding OtKcer for assignment to duty.

iJletiical Jtcms anti Hews.

Marri.ige v. Celibacy. — M. Bertillon read a paper
at the sitting of the Academy of Medicine of Paris,
on the 14th of November, entitled '• Influence du
marriage sitr la duree de la vie et stir les maladies
intellectuelles on morales," maintaining the healtliful
influence of conjugal association as compared with
that of celibacy, and using as evidence the statistics
of France, Holland, and Belgium. According to his
figures, between the ages of twenty- five and thirty
years 1,000 married men furnish G deaths; 1,000
bachelors, 10 deaths; and 1,000 widowers, 22 deaths.
From thirty to thirty-five years of age, the same classes,
respectively, furnish 7, 11, and 17i deaths. From
thirty-five to forty years of age the mortality is 7i, 13,
and 17i per 1,000 respectively. And so on in a series
of table's for all ages, the married man has always the
advantage of the single man ; but what is the explana-
tion of the fact that among widowers the mortality is
even greater than among bachelors? In the case of
men married under the age of twenty, the statistics
show anything but a salutary result. Out of 8,000 of

THE MEDCCAL RECORD.

this clas?, the mortality was, bi'fore mnrria<r«', only 7
per 1,000 ; after ntarruKje it wng 50. This is a constant
result in Paris, ]k'l;.'iuin. ami Ilollaml. Everywhere
young mairii'tl ju-oplf, IVoni ciplit^-cii to twenty years
of ape, die as fast as old people of from sixty lo seventy
year/< of ape. Tiic conclusion seems evident, according
to Ilufeland, " that the premature use of the genital
organs i-; the most sure means of inoculating old age."
This astonishing mortality being due to no special
malady, but to a general enervation, which, witliout
doubt, renders tlienj a prey to any disease.

The same advantage of the marriage state obtains in
the casr; of females, though up to the age of thirty the
ditTerence is not .<;o apparent as in the other sex. From
thirty lo thirty-five the morlalitv is 11 per 1,0U<» for sin-
gle women, a:id only 9 [)er l.OOd for married women, and
this difference increases up to the age of fifty-live. Thus,
from fifiy to fifiy-fivc years t)f age 1,000 wives furnish
only 15 or IG deaths, vvliilst as many single women or
widows furnish 2G or 27. This advantage remains
very notable beyond that age, diminishing but little.
In France, however, under twenty-five, and in Paris,
under twenty years of age, marriage is far from favor-
able, but even injurious, as in the case of males. The
mortality of unmarried girls of from fifteen to twenty
is 7.53 per 1,000 ; the mortality of wives of tlie same
age^being 11.86. The mortality of girls from twenty
to twenty-five is 8.32 ; of wives of the same age, 9.92;
the difference in this class being due, no doubt, to preg-
nancy and its accidents. The deadly effects of widow-
erhood in men is equally shown in the case of widows
up to the age of tliirty, and after forty-five more single
women than widows die.

The influence of marriage on criminality is not le.^s
striking. Whilst the crimin.'^lity of single men for
crimes against the person is 100, in married men it is
only 49, and 45 for offences against property. The
criminality of widows and widowers approaches that
of celibacy. Relative to suicide, the author concludes
that this cause of death is reduced one-half by mar-
riage.

Chair of Physiology ix the University of Paris. —
MM. Bt?clard and Yulpian are candidates for the afeve
position, left vacant by the death of Longet.

Is Insanity on the Increase ? — Dr. Henry Maudsley,
writing on this subject in the British Med. Journal, says:
"It may hd true, and probably is true, that there is
more insanity, and more occurring insanity, in propor-
tion to the population now, than at the time when our
forefathers followed Boadicea to the battle; but that so
many more persons should be yearly going mad now
than twent3'-five years ago, seems tj me a supposition
which is, I will not say preposterous, but is certainly
not probable in itself, and not supported by facts.
There is abundant evidence of a gradually improved
registration of insanity, and of a great increase in the
returns in consequence of that improvement, but there
is not yet satisfactory evidence of anything more."
''Some part of the difference," he says, '' is owing to
the fact that certain patients are registered as lunatics
now who would never have been thought so in times
past." Also. '• a lower rate of mortality and a lower
percentage of recoveries may account for an increase in
the total amount of insanity."

Conjugal Onanism. — In an important clinical lecture
on " Conjugal Onanism and Kindred Sins," by William
Goodell, M.D., Clinical Lecturer on the Di.seases of
Women and Cliildren,University of Pennsylvania (T'/oTtf.
2fed. Times), the resulting disorders from imperfect
se.vual congress, on the part of man and wife, are plainly

discussed. lie says the hu.sband suffers mentally,
because no inan can behave in so unmanly a way witi -
out a keen sense of self-abasement, without being stung
by the chastisement of remorse. The wife suffers the
most, because she both sins and is i-inned against. She
sins, becau.se .she shirks tho.se responsibilities for which
she was created. She is sinned against, because she is
defrauded of her rights. The excessive stimulation
of the whole rt'productive ap[)aratus remains unap-
pea.sed. Excessive coitus, even when normally per-
formed, and especially indulged in during the fatigue
and discomforts of the honey-moon journey, .so often
the starting-point of uterine disease, with the disorders
resulting therefrom, were alluded to.

Such papers are especially needed at the present
time, as some members of prominent societies, like the
'•London Dialectical Society," have been earnestly ad-
vocating plausible arguments against " Over-Population
and Large Families."

Excision of the Elbow-Joint. — John Reddy, M.D.,
Physician to Montreal General Hospital (Canada Afed.
Journal), relates a favorable case of excision of the right
elbow-joint, for caries in a patient aged seventy-two
years. The olecranon was first removed, then the arti-
culating ends of the radius and ulna, to the extent of
about three-quarters of an inch, and lastly, about an inch
of the end of the humerus. Six months subsequent to
the operation, the patient enjoyed a tolerably fair use
of the arm, complete flexion being the most deficient
movement. Dr. Reddy considers this case establishes
the fact that advanced age does not prove so great &
barrier as is generally supposed to excision of the
elbow-joint. The only two published cases, he re-
mark.s, where it had been performed late in life, were
first by Mr. Erich.sen, at the age of sixty-three, issue
successful ; second by Mr. Beckerslette, of Liverpool,
aged sixty-four, Avhen the patient died of exhaustion
on the twenty-sixth day.

Hesit.vtion in Curing Eczema. — Mr. Milton {Med.
Press and Circular) for years has done his best, in
every instance, to check the discharge of eczema as
quickly as possible. During that period above 5.000
cases have passed under his notice. He concludes that
the fear of curing eczema, of however long standing it
may be, and how^ever delicate the health of the patient,
is not warranted by either proof or analogy ; that no
known agent po-sesses the power of repelling eczema;
that we can cure it only by means which improve the
health at the same time; and that it is as justifiable to
arrest its discharge as that of diarrhoea or cholera. All
that has been said of eczema may be said of ulcer;
there is no danger of healing it up, no bad symptoms
ever aro.se from doing so.

Alabama Insane Hospital, Tuscaloosa. — The elev-
enth annual report of this institution, for 1871, exhibits
the following: Oct. 1, 1870 — there were 222 patients
under treatment. Since then, 139 have been admitted,
making an aggregate of 361 under treatment during
the twelve months ending Oct. 1, 1871. Of this num-
ber 33 were discharged recovered, 9 improved, 5 un-
changed, and 26 died. Remaining in hospital Oct. 1,
1871, 288.

Of the causes of death, marasmus carried off 8, epilep-
sy 4, exhaustion 4, heart disease 3, and renal disease 2.
Of those remaining 149 are men, and 139 are women —
50 are colored. The building was built to accommodate
just 250 patients. The cost per annum, of each patient,
was $211.86. The average cost to the twenty -two
prominent insane institutions of the United States, per
capita, for the maintenance of the insane, is $272.48

THE MEDICAL RECORD.

per annum. The treatment in this hospital was based
upon the recognition of disordered mental manifesta-
tions as consequent upon physical lesions, in accord-
ance with tile advanced vicAVs in psychology.

The resident ojicers are: P. Bryce, AI.D., siipt. and
physician; John Little, AI.D., assistant physician.

SuLPiiuu IX THE United States. — On the shores of
the Mississippi, below New Orleans, two miles from
the sea, in malving an artesian boring, a stratum of pure
sulphur, 100 leet thick, was discovered at the depth of
54;5 feet. — Xew Remedies — Trausl. from Zeitschrift des
Oesterr. Apothek.- Vereins.

Electrical Prize. — The prize of fifty thousand francs
($10,000), ofTered by the Minister of Public Instruction
in France, April 18, 1866, for five years, for the most
useful application of the Voltaic Pile, was not granted
to any candidate. The competition has been extended
for another five years, terminating Nov. 29, 1876.

The Actonian Prize. — The prize fund of two hun-
dred guineas, offered by the Royal Institution for "The
Theory of the Evolution of Living Things," will be
awarded this year, as a single prize, or in sums of not
less than one hundred guineas each. Competitors
should send their essays to the Royal Institution before
June 30, 1872. In December, 1872, the adjudication
will be made.

Medical Fees and Professorships, etc.. Abroad. —
A doctor who is not celebrated costs four or five Eng-
lish shillings in Paris, and a guinea in London. A
professor at the College of France receives £300 ; at
the Sarbonne, £480 ; or at the Paris School of Medi-
cine, £400. A professor at Oxford has often from
£1,000 to £3,00t>. The head-master at Eton has
a salary of £6,680; of Harrow, £6,280; of Rugby,
£2,960.

Philadelphia Medical Times. — Dr. James Tyson, of
Philadelphia, has retired from the position of assistant
editor of this journal, in consequence of the demands
made upon his time by professional engagements.

The U. S. Army Medical Museum. — Fifteen hundred
and sixteen new specimens were added to this Mu-
seum during the year ending June 30, 1871. The total
number is 15,018. During the year, 15,000 persons
visited it.

A Western Monthly Medical Journal Changes its
Name. — The name of CinciJinaii Medical Hepertori/,
with the opening of the year, has been changed to
Cincinnati Medircd Keics. The editor is J. A. Thacker,
M.D., assisted by the following associate editors: Drs.
R. C. S. Reed, A. J. Miles, and D. D. Bramble.

The Agency of the Mind in Etiology, Prophylaxis,
AND Therapeutics. — Prof. Austin Fhnt, New York (Am.
Pracdtioner)^ in a practical paper on this subject, re-
marks : That the proper exercise of all the faculties of
the mind, the sentiments as well as those belonging to
the intellect, is the great requisite fur mental health,
and consequently for happiness.

Mental disorders not amounting to insanity, it seems
to him, are not sufficiently considered by medical wri-
ters, and their importance is apt to be underestimated
b}^ practitioners of medicine. These disorders not in-
frequently precede and lead to insanity ; and there are
grounds for the belief that timely attention to the for-
mer, on the part of the physician, would often prevent
the latter. Those who give exclusive or special atten-
tion to the treatment of cases of insanity, do not, as a
rule, see patients until after they have become insane.
The treatment of mental maladies, which precede and

lead to insanity, must devolve upon the general prac-
titionei-.

In so far as bodily health and vigor afford protection
against disease, the exercise of these sentiments is pro-
phyhvciic. The state of the mind of a patient enters in
many cases more or less largely into the prognosis.
To develop and maintain this, hope and conlidence
siiould enter, within proper limits, into the aims of the
physician. In regard to the success in treating diseases
and obtaining practice, the mental temperament of the
practitioner has much to do in this matter. Some pliy-
sicians are prone to look always on the dark ^ide of
cases. Others are distinguished for always taking the
most hopeful view of cases; they look ever on the
bright side. The efiect is often more powerful than
medication. There is an injudicious extreme in the
latter direction, and between this extreme and the op-
posite there is a golden mean ; but if there must be a
deviation from this mean, it is desirable that it should
incline to hopefulness rather than despondency.

Aiken, South Carolina, as a Resort for Invalids.
— This town is situated in the northwestern portion of
the State, 120 miles from Charleston, and 17 miles from
Augusta, Georgia. It is 600 feet above tide Avater at
Charleston, and 400 feet above the Savannah river at
Augusta. The South Carolina railroad passes through
the centre of the town, making direct connection with
the Charleston steamers from New York and other
northern ports. The township contains 4 square miles,
situated on a nearly level plateau. The streets are all
150 feet wide, crossing each other at right angles. The
building lots or squares contain 4 acres each, with one,
two, or more houses. The streets are all well shaded
with a great variety of the original forest trees ; such as
oak (five or six varieties), pines, China, wild orange,
mulberry, and black walnut. The soil is a white sand,
with an under-lay of red clay. The sand varies in
depth from 12 inches to as many or more feet. The
wells and numerous springs furnish an abundant supply
of pure, sweet, and limpid water. The welis vary from
80 to 125 feet in depth. From the nature of the soil
and the elevated location of the town, the climate is
dry and moderately bracing in winter, rendering it a
favorite place of resort for invalids from the North,
especially those afflicted with pulmonary disease, from
the slight cases of bronchitis to those of a more grave
nature, and chronic affections of the nervous system.
The climate in winter is delightful. Invalids can exer-
cise in the open air from morning until evening without
any unpleasant effect ; seldom needing an overcoat in
the middle of the day. The dense pme woods, Avith
their agreeable odor, furnish delightful drives and lides
over the hard, level sand. This climate possesses more
tonic properties than the milder but more debilitating
climates of Florida or any of the West India islands.
It is also entirely free from the moisture of those places
situated near or surrounded by salt water. Those who
visit Aiken as invalids are frequently injunjd by not
taking timely advice, either of their physician at home
or of some one resident in this place, as to exercise,
diet, and general hygienic management while here.
They come here for the benefit of the pure, fresh, and
invigorating air; and are apt to think they cannot liave
too much of it. Or else they may arrive when we are
experiencing one of our cold, windy "spells of weather,"
and shut themselves in their rooms, stuff all the cracks
with cotton, and with a rousing fire of Black Jack and
light wood deceive themselves into the belief that they
are doing the best they can to receive the full benefit
of the climate ; or else heap curses and maledictions
on the climate and those whose advice they followed in

THE MEDICAL RECORD.

coming here. A little advice from an intelligent phy-
sician, who imdor-itniula llic climate and it;' effects,
woulil save all this; and in many ca«e.s the life of the
patient would be prolonged if a permanent cure was
not effected.

The accommodations for inva'ids are for the most
pari first-class. With the hotel, the Sanitarium, and
private hoarding-houses, there arc aocommoJations for
about 400. Most of the private boarding liouses are
situated either in tlie centre of the town, or near
enough to bo of easy nccoss.

Prof Saml. Henry Dickson, M.D., of Jefferson Medi-
cal College, Pliiladiliiliia, a former resident of Charles-
ton, says: " I have long regarded the town of Aiken,
or rather the country immediately surrounding it, as
among the most agreeable arid healthy loc:ditie3 in our
Atlantic States, so far as climate and topographical
conditions are concerned. A sandy soil, and an at-
mosphere fragrant witli tlie pleasant smell of the pines
which form the prevailing growth for miles about, a
genial, sunshiny sky, pure air, and limpid, sweet water
constitute a sjt of circumstances highly favorable to
the preservation of health to the sound, and its resto-
ration to tlie invalid. The region is especially adapted
as a winter and spring residence to those generally
who suffer from affections of the respiratory organs
from the most serious cases of consumption to the
lighter but often tenacious attack of chronic catarrh
and bronchitis. I have often been called on to give
advice to pati?nts laboring under these maladies and
chronic affections as well of the digestive organ, and
have found them in a majority of instances to be
benefited by a residence in and near Aiken, both in
winter and summer.

'• Dr. Percival. a resident of Aiken, presented to the
American Medical Association, at its meeting at Wash-
ington two years since, an account of this place of re-
sort for Northern invalids which, however wrong it
may seem, is really entirel}' truthful and without exag-
geration." From an experience of one season at
Aiken, I can bear witness to the truth of all this,
although the last winter was one of unusual severity
not only in Aiken but throughout the States, Florida
not even excepted. This may and probably will not
occur again in a number of years. Even last winter,
the benefit received by those w-ho were advised to be
prudent, more than overbalanced the evil to the oppo-
site class.

A great variety of vegetables are raised here in
abundance, and can be procured fresh nearly the year
through. The best of beef and mutton, from East
Tennessee, can be procured, with but little trouble, at
the markets in Augusta. Poultry and game are
abundant. A great variety of fish can be had from
Charleston and Augusta. Oranges from Florida. Ap-
ples from the North and West. Canned fruits are as
cheap as in New York, and can be had in every va-
riety. The material for food is abundant. There is no
necessity for any one to go hungry or contract dj'spep-
sia if he only hits upon the right place to indulge his
gastronomic propensities.

" Fem.vle Pills" .\s Abortifaciexts. — The sum
paid for these quack remedies in the United States is
estimated by investigators at about one million of dol-
lars. Dr. Ely Van De Warker, Syracuse, N. Y. {Jour.
Gyncpcological Society) believes the crime of abortion is
more common in Protes'ant countries than in Catholic.
Among the Roman Catholics the indi.screet maiden re-
ceives the crown of motherhood. She has been taught
from childhood to bow before the reality of an unborn
soul. To the Protestant woman of many sects such a

reality cannot exist. The belief finds no place in her
heart, that the embryo of coming manhood within
her has roused pulses of love not unmarked in heaven.

UiiinXhv Calcilus in CniNA. — According to J. G.
Kerr, of Canton, (.'hina (iV. V. Med. Journal), stone in
the bladder is confined almost entirely to the province
of Canton; it is a remarkable fact that the disease is
not known to exist only in tlie Southern portion of
the Chinese Empire. Why the disen.se should be so
common in the South of China, on latitude 2'.\Y, and
entirely absent in the central or northern parts, is a
curious question, not easy to be answered satisfactorily.

The first operation for stone in the bladder pcrlbrmed
in China was in 1844, by the Rev. P. Parker, M.D., the
ibunder of the Medical Mi.ssionary Society, and now a
resident of Washington, D.C. From that time ti;
1853 about 37 cases were operated on by him. Since
the year 18-")(J lithotomy has been performed 187 times,
with 19 deaths; the cases of lithotrity for the same
period amount to 30, with 3 deaths. The ordinary
lateral operation with the s?alpel has been performed iu
most of the lithotomy cases. Generally the incision
was not extensive, and reliance was placed on dilatation.
In one or two cases the median ojieration was resorted
to.

Sir Henry Thompson's lithotrltc, made by Wei^, was
used in most of tlie lithotiity cases, and seemed to be
as nearly perfect in its adaptations to the purpose re-
quired as it is possible for any instrument to be.

Thirty-seven of the lithotomy cases were operated
on by Dr. F. Wong, a Chinese physician educated in
Boston,'' Mass., and in Edinburgh. He is the only
Chinese who has performed the operation.

Maltine. — This substance, called diastase, first re-
ported by Payen and Persoz in 1833, is recommended
in dyspepsia, either with or without pepsine, by Prof.
De Renzi. The subjoined formula is laid down in La
Kuova Ligiiria Medicah : R. Maltine, centigr. xv. F.
pil. No. 3. One pill before each meal. K. Maltine,
centigr. v. to x.; Pepsine, centigr., c. to cl. F. doses No. 2.

Stramonium ax Axtidote to Opium Poisoxing. —
In two cases, Dr. D. B. Putnam, of Boston, Mass. {Boston
Med. and Surrj. Journal), has used stramonium as an
antidote to poisoning by opium, and from the prompt-
ness and certainty of effect manifested in these cases,
he would suggest to others a trial of its virtues in
cases of this character.

Medical Department of the Universitt of
Vienna. — This institution was founded in 1787, by the
Emperor J'rancis Joseph II. It is of brick, two and
a half stories high, and covers an area of ten acres or
more. The number of wards is 110, and they contain
2,500 beds. There are 28 civil and 52 medical officers ;
all of whom receive pay. About 20,000 patients are
admitted annually, besides tliose in the lying-in wards.
From eight to ten thousand children are born in the
obstetrical wards during the year. Bilroth and Du-
meicher are the surgeons, Braun and Spiit the obste-
tricians and gynaecologists, and Hebra and Neumann
hold the chairs of dermatology. Sigmund and Zeisel
lecture on syphilis, Jiiger on the eye, and Rokitansky
on |)atliological anatomy. Excellent as is the faculty
and splendid the clinics, it is from the assistants that
the most practical le?sons are obtained. They teach
everything. Pro*'. Braun is about fifty years of age,
has a pleasing face, and is thoroughly German in ap-
pearance, lie delivers his lectures sitting; speaks
very slowly and distinctly, but with little animation,
offering in this respect a striking contrast to the fiery

THE MEDICAL RECORD.

style of his nssistant, Rokitansky, Jr., wliobkls fiiir in
his chosen field to rival the reputation of his illustrious
sire. — Vienna Corresp. Am, Practitioner.

Retention of a Wooden Pessary Skventekn
Years. — Dr. J. J. Kenipe, of Milwaukee {NortluL-esteni
Med. and Surg. Journ.), recently removed a ring-shaped
pessary from a German woman, which was forcibly in-
troduced, 17 years ago, by a physician in Germany for
complete prolapsus uteri. The pessary, made of a wood
similar to our hard maple, measured three and one-
eighth inches in diameter, and the outer border was
one-half inch in thickness. The instrument originally
was covered with leather, which came away about
eighteen months after introduction.

The patient had sought to obtain partial relief from her
suffering by repeated and long-continued traction upon
the pessary, and in this way an urethro-vaginal fistula
was originated— by pressure of the tissues between the
arch of the pubes and the outer border of the ring.

Bichloride of Methylene. — Samuel Theobald, M.D.,
of Baltimore, Md., London correspondent of the Bait.
Med. Journ., writes that the advantages of bichloride of
methylene as an anaesthetic, have been largely tested
at Moorfields Hospital, London. No dangerous or un-
pleasant symptoms caused by its administration have
been noticed there. The advantages which it possesses
over chloroform are, that it produces its effect much
more rapidly, and is more evanescent in its action.
These properties recommend it more especially for ope-
rations of short duration. In its administi-ation, it
should be diluted with a much smaller percentage of
air than chloroform. To an adult from one or two
drachms may be administered at once, and this will
generally prove sufficient if the operation is of short
duration. If desired, however, it may be repeated (four
or five times), in drachm doses, as soon as its influence
begins to pass off.

The Sphygmograph. — This is the title of a beauti-
fully printed monograph of thirty pages, published by
Wm. Wood (fc Co., and written by Edgar Holden,
M.D., of Newark, N. J., in which the subjoined instru-
ments devised to carry on his observa'.ions are particu-
larly referred to, viz. : the sphygmograph already
described in the Medical Rkcord. an artificial heart
and capillary apparatus made of rubber ; a large sphyg-
mograph two feet in length, adapted to record its
workings.

The author announces that this essay, originally read
before the Medical Society of New Jer.sey, is prepara-
tory to a larger work on the practical value of the
sphygmograph and the physiology of the circulation.
The writer, after referring chiefly to tracings of the
pulse in connection with cardiac pathology, says in
closing: " With a new principle and a simpler and less
costly instrument within reach, sphygmography will
rise into a definite and useful science. Certain it is
that by it, even now in its immaturity, we may detect
deviations from perfect health not discernible by any
other means, and consequently in at least one, and a
growing interest in this country, namely, the estima-
tion of possible longevity, it will be invaluable."

The attention and perusal of all interested in the
workings of the sphygmograph is called to this useful
book, which presents, in a form convenient for reference,
the results of his own experience.

Transactions of the Medical Society of the State
OF North Carolina. — This pamphlet, containing the
minutes of the eighteenth annual meeting of this Soci-
ety, held at Raleigh, N. C, May, 1871, also exhibits
creditable papers by the following gentlemen : " Report

of a case of Scleroderma atid two of Empyema," by
Robert J. Hicks, M.D. ; "Operation for Traumatic
Aneurism of the Superficial Palmar Arch," " Cranio-
tomy and Operation for Vesico- vaginal Fistula," by E.
Burke Haywood, M.D., Raleigh. Dr. R. L. Payne, of
Lexington, gives an interesting address on "Some of
the duties of the Avorthy i)hysician, and some of the
obligations due the worthy physician by the commu-
nity." The following officers were elected lor the en-
suing year: Premlent, Di-. William G. Hill. Raleigh,
N. C. ; Vice-Presidents, Drs. H. W. Faison, R. J. Hicks,
(iid. H. Macon, and W. A. B. Norcum ; Treasurer, Dr.
J. W. Jones, of Farborough ; Secretary, Dr. James
McKee, of Raleigh.

Artificial Milk. — Among the melancholy records
of the siege of Paris may be counted those on the
utilization of strange materials for food ; not the least in-
teresting of these being the researches of M. Boillott,
M. Dubrunfant, and M. Charles Fua on " Alimentary
Fats."

"Alimentary Fats" is a wide expression, including
some rather unsavory hydrocarbons and very curious
refuse materials. The main object of these iiivestiga-
tions was to determine how such substances may be
" usefully employed in alimentation," or, in plain, un-
sophisticated English, how to make butter from candle
ends, dirty drippings, colza oil, fish oils, the refuse of
slaughter-houses, the restored greasa of the wool-
dresser, etc. The general result has proved that the
"frying process" is triumphant over its rivals; that by
simply raising the temperature of the fat to 140° or
150" centigrade, and in the mean time cautiously sprin-
kling it with water, the cellular tissue, the volatile oils,
the rancidity, offensive odors, and all other non-senti-
mental impediments to "alimentation " are removable.

This frying process has already effected something
like a revolution in the industry of soap-boilers, some
of whom have changed their trades to that of butter-
fryers.

M. Dubrunfant is not content with superseding the
cow in the matter of butter, but has made similar at-
temps upon milk. He contends that milk is simply an
emulsion of neutral fatty matter in a slightly alkaline
liquid, such as can be artifically imitated ; and that the
process of churning consists in hastening the lactic fer-
mentation, thereby acidifying the serum of the milk,
and at the same time agglomerating the fatty matter
which the acidity sets free from its emulsion. He fur-
ther controverts the cellular theory by showing that
fat-globules of milk do not display any double refrac-
tion, as do all organized membranous tissues.

Having thus examined the theoretical constitution
of milk, he proceeds to the practical method of imitat-
ing it, and gives the following directions: Add to half
a litre of water forty or fifty grammes of saccharine
material (cane sugar, glucose, or sugar of milk),
twenty or thirty grammes of dry albumen (made from
white of egg), and one or two grammes of sub-car-
bonate of soda. These are to be agitated with fifty or
sixty grammes of olive oil, or other comestible fatty
matter, until they form an emulsion. This may be
done with either warm or cold water, but the tempera-
ture of 50° to 00° C. is recommended. Tlie result is a
pasty liquid, which, hy further admixture with its own
bulk of water, assumes the consistency and general ap-
pearance of milk.

Luxuriously- minded people, who prefer rich cream
to ordinary milk, can obtain it by doubling the quantity
of fatty matter, and substituting two or three grammes of
gelatine for the dry albumen. The researches of Dumas
and Fremy having reinstated gelatine among the nitre-

THE MEDICAL RECORD.

genmis nlimentftry matoriala, M. Dubniiifniit profers it
to albumon ; it is rlioai)or, more easily obtaiiicil, and
tlio sliglit viscidity wliicli it (ifivis to tlie litjuid, materi-
ally assists the formation and maintenanie oftlie emul-
sion, liy sulislitulinp vegetable idbuinen for the white
of cpg or pelatine the vegetarian may prepare for liim-
BeU a milk that will satisfy his uttermost aspirations. —
Nature.

A New Qlautkrly lias made its appearance in Eng-
land, called ' T/ir (rermnii Qiiarlerli/ Mdijazine: a Series
of Popular Es.«ays on Science, History, and Art.'' The
first number contains three papers : — " The Cranial
AfTmiiics of ^[an and the Ajyo," by Rudolpli Virchow ;
" Sight anil the Visual Organs,'' by A. von Graefo ; and
" Tlie circulation of the Waters on the Surface of the
Earth," by II. W. Dove.

Conjoint Examinino Board. — It is stated that all
of the English Universities have accepted tlie draft
scheme as proposed by the College of Physicians and
the College ot Surgeons, for a Conjoint Examination
Board. Tliere appears to be every probability of its
soon being put into effect.

Loris KosscTii communicates to the Neue Freie
Presse of Vienna the remarkable curative qualities pos-
sessed by a grotto near Pistoies, in the Valley of Luc-»
ques and Pisa, the virtues of which consist in radically
curing the gout.

The treatment is easily followed, and lasts from eight
to fifteen days.

The patient descends into the grotto, which is well
lighted, covered with a bathing-gown. There he has
only to sit and admire the stalactites, or converse with
his friends. After ten minutes he sweats profusely,
but not disagreeably.

After an hour he is taken out. wrapped in a flannel
covering, and after reposing a little, subjected to a cold
shower-bath.

The curative principle of the grotto is, however, an
enigma.

In the warmest parts of the grotto the air does not
show more than thirty-two to thirty-four degrees (cen-
tigrades), and is less oppressive than the air outside;
the water is still colder, but it is heated by the air, the
chemical composition of which resembles that of atmos-
pheric air ; the only difference being a slight addition
of azote.

Ko.-suth attributes the remarkable qualities of the
grotto to electro-magnetic agents.

The subterraneous grotto in question was discovered
some years ago by a number of quarrymen engaged in
excavating stone.

An E.xtremely Curious Pathological Fact, in the
highest degree interesting to the scientific world, was
signalled this week in Paris.

On the 6lh of February M. Roux, sluice-keeper at
the station on the Seine, opposite the mint, withdrew
from the river the evidently lifeless form of a woman
who had thrown herself in two hours previously, but
who in spite of the most active measures, could not be
discovered sooner.

The body laid upon the quai was cold and rigid, the
face livid, the pulse of the poor woman had ceased to
beat, and so sure were the bystanders she was dead
that not the slightest effort was made to restore her to
consciousness. On the arrival of the ))olice commissary
Dr. JuRien thought he still perceived some feeble in-
dications of life in the apparently inanimate body.

On minute examination he found that, notwithstand-
ing her long submersion beneath the Seine, the
functions of life had not completely ceased.

Dr. Jullieii in turn tried fumigations, friction.'', and
the breathing of air into her lungs. The beatiiij^ of the
heart, feeble and uncertain at first, gradually became
stronger and more regular, until she finally became
conscious, and could with safety be transported to the
nearest hospital.

In falling into the Seine .she had been seized with
a syncope, which during the two hours of her immer.sion
in the river had completely suspended the functions of
life. Her name is Jeanne Duboi.s, and adilre.ss, 52 Rue
de Seine.

Monsieur Tei.lier ha.s di'^covered a new method of
preserving meat for an indefinite period of time, by
submitting it to the action of melhylic ether.

When once it is proven that meat thus treated, pos-
sessing intact its qualities of freshnes.s, may be trans-
ported to Europe at little cost, in a frozen state, from
Australia, South America, and the west and south of
United States, the welfare of the mas.se3 in overstocked
Europe will be greatly advanced ; with the boundless
resources of the New World at their disposal on easy
terms, a new era will be opened to the working
classes.

Swallowing a Fork. — An individual in Florence
named Hegisto Cipriano, while imitating the tricks of
Japane.se jugglers, was seized with a fit of coughing,
and had the misfortune to swallow the metal fork with
which he was experimenting.

Conveyed to the hospital, the most experienced
physicians there endeavored by every possible means
to extract the fork from tlie stomach, but without suc-
cess.

As he is able to eat and drink with the greatest
freedom-, and enjoys general good health, the medical
men attending him are in hopes that the fork will be
gradually digested, and that ti)e result of the accident
will not be fatal.

Home for Incurables, West Farms, X. Y. — The
Fifth Annual Report of this Institution gives the fol-
lowing exhibit: — Whole number of patients under the
care of C. F. Rodenstein, M.D., the attending physician.
during the year ending June 1st, 1871, 57; number in
house at last report, 35 ; admitted during the year, 22 ;
died, 9 ; removed, 5 ; now under treatment, 43. Clas-
sification of diseases. — Hemiplegia, 13 cases ; debility,
6 ; dementia, 4 ; epilep.sy, 5 ; progressive locomotor
ataxy, 3 ; phthisis pulmonalis, 4 ; paraplegia, 2 ; rheu-
matic gout, 4 ; and softening of the brain, 2. The
remaining 12 cases represent as many different diseases.
The annual meeting of the Society was held at Asso-
ciation Hall, New York City, June 12, 1871, and
appropriate addresses were made bv Chancellor Crosbv,
Rev. Noah H. Schenck, D.D., Rev. S. H. Tyng, Jr.,
and Hon. Erastus Brooks. Contributions are sohcited,
which may be sent to J. D. Vermilye, Treasurer, Mer-
chants' National Bank, 42 Wall street, N. Y, City.

The Photometer. — A newly-invented photometer
proves that light penetrates 100 fathoms below the
.surface of the sea — 70 fathoms more than hitherto sup-
posed.

A Centenarian. — The most remarkable centenarian
alive is probably Thomas Fitzgerald, of Rhinebeck,
N. Y.. who is one hundred and eight years old. He
lives with one son, while his wife, one hundred years
old, lives with another at Rondout and keeps house for
him. Mr. Fitzgerald u.ses tobacco, but has always
been strictly temperate. He is very deaf, but his eye-
sight is good, and he can thread a needle at arm's length.
He strops his razor, shaves himself, dresses and

THE MEDICAL RECORD.

undresses, nnd Avithin the year hns chopped and put
up six cords of wood. His occnpation has been that of
a fisherman and laborer. He is a native of Irehind,
and was thirty-four years of age at the time of the
Irish rebellion in 1798.

Berardius Aruxxii. — A unique specimen of the
rare animal, lierardius Arunxii, of Dnverney, 30 feet in
length, has been recently given to the Hunterian
Museum, by Mr. Erasn.us Wilson. Only four of these
creatures have been discovered, all on the coasts of
New Zealand.

De.vtii from Hypodermic Injection of Morphia. —
Dr. Stanton, of New Brighton ,Pa., relative of the late
Secretary Stanton, and Auditor-G-eneral of the State
of Pennsylvania, lately died from the effects of an
hvpodermic injection of morphi;), administered by him-
self to produce sleep, in tlie inner part of the arm near
its junction with the shoulder. The dose was about
one grain. Death occurred six hours after its admin-
istration. In the opinion of those physicians Avho
witnessed the death scene, his death was caused by
the unusually prompt and complete absorption of the
morphia, prostrating a system already struggling with
cadaveric poisoning.

Scarlet Fever in Great Britain. — During the last
sixteen years the losses i'rom scarlet fever in Great
Britain were not less than 100,000 lives.

Chloride of Sodium. — In the year 1871 nine million
bushels of common salt Avere manufactured in the
neighborhood of Syracuse, New York.

Analysis of Milk. — Dr. P. Schweitzer, of the School
of Mines in Columbia College, New York (Journ. A])-
2ilied Chemistry), in his examination of the milk fur-
nished to the inhabitants of this city, reports that in no
samples were any injurious ingredients found, tiieonly
adulteration being water.

The specific gravity of pure milk adopted by the
English is 1.029; it should contain from 12i to 13 per
cent, solid constituents, the rest being water. The
solid portions are made up of

Ordinary Milk. Condensed Milk.

Ash 0.70 2.60

Butter 3.80 13.12

Casein 4.10 14.44

Sugar 4.20 16.30

12.80 46.46

New York State Lunatic Asylum, Utica. — In a
voluminous paper on "Materialism in its Relations to
the Causes, Conditions, and Treatment of Insanity,"
read before the Association of Superintendents of Insane
Asylums, at Toronto, by II. B. Wilbur, M.D., Sup't of
the New York Asylum for Idiots (Journ. of Psyc/wlo-
f/ical Medicine), the statistics of the Utica Asylum for
27 years ending Nov. 30, 1869, are cited to show that
the percentage of recoveries, during the later years, has
not been an increasing one. He would not be under-
stood as presenting them to prove that they are less
favorable than in the case of other institutions during
the same period, but as showing that the modern
system of treatment, based upon the exclusively " physi-
cal basis" theory of insanity, is no more successful
than in former times, though it must be conceded that
the resources in the way of remedial agencies have
been greatly enlarged.

The partial statistics of three Massachusetts institu-
tions, he believes, indicate that the medical treatment,

when pushed, is no more successful than when less
vigorous medication is employed.

According to this author, in the last six years, the
average annual cost of medicines, for each patient,
at the Utica Asylum, has been $7.94. In the six years
of Dr. Brigham's administration, Avhen the moral treat-
ment was made very prominent, he states that the
average annual cost of medicine and medical supplies
for each patient was $1.15.

The Man with the Iron Jaw. — Mons. D'Atalie, or, a.s
he is commonly known, " The Man with the Iron Jaw,"
was presented recently at the surgical clinic of Pro-
fessor Mears, in the Penn. College of Dental Surgery,
for an examination of his maxillary apparatus. From
early life he has been engaged in a gymnasium. His
first efibrt to raise weights, grasped by his teeth, was
made tiiree years ago, when he made an attempt to lift
a heavy table. This effort was successful, and now he
is able to raise seven hundred pounds. His maxillary
apparatus does not present any extraordinary develop-
ment; on the contrary, there seems to be an absence of
any very full development of the various parts which
enter into its formation.

Mons. D'Atalie holds heavy weights by placing the
part seized between both the anterior and postei-ior
teeth, so as to employ all the elevators of the jaw. His
power does not reside alone in the muscles of the jaw
— those of the neck and body play an equally im-
portant part in all of his feats of strength. — Denial
Times.

Proceedings of the State Medical Association of
Arkansas. — The second annual session of this Society
was held at Little Rock, Arkansas, November 5th and
6th, 1871. The annual address was delivered by the
President, Dr. P. 0. Hooper. Interesting communica-
tions were read by Drs. R. G. Jennings, W. H. Haw-
kins, E. R. Du Val, and Geo. W. Lawrence. Nine local
medical societies, representing fifty members, compose
the parent society. The following officers were elected
for 1872: President, J. M. Holcombe, of Pine Blufi";
Vice-Presidents, Drs. O. A. Hobson, J. F. Davies, and
W. "W. Bailey ; Recording Secretaries, Drs. E. V, Deuell
and Ed. Cross, of Little Rock ; Correspondimj Secretary^
Dr. Claiborne Watkins, of Little Rock; Treasurer, Dr.
J. B. Bond, of Little Rock.

Chinese Surgery. — John G. Kerr, M.D., Chief-Sur-
geon of the Canton (China) Hospital {Cin. Lancet and
Observer), writes that the department of surgery in this
empire can scarcely be said to exist, beyond the appli-
cation of caustics and plasters to tumors and ulcers, and
of poultices to broken bones. They are entirely help-
less. There is no native doctor in all China who can
give aid in any case of accident or disease which re-
quires manual or instrumental interference. The ines-
timable benefits of operative surgery in all its branches
are unknown to them, except so far as they have been
derived from a few foreign physicians and the pupils
instructed by them. They are entirely without surgi-
cal instruments, and all the apparatus which modern in-
genuity has applied to the relief of injuries, deformities,
and disease. In the instruction of students there, by
foreign medical men, there is a want of suitable text-
books in the Chinese language. A beginning was made
in this department some years ago by Dr. Hobson, of
the London Missionary Society, who published the out-
lines of several branches of medicine in four volumes.
He inquires : Are there not many of those who are
aspiring to the honors of the medical profession, who
will be ambitious thus to benefit so large a portion of
the human family ?

THE MEDICAL RECORD.

The Drco Trade or Chicago and thk Fiiik.— Of
the 100 r.'tftilers of driips in Chicago, upwanls of (ifiy,
or more than cne-thiid of the whole niinibor, lost their
all ill tlie wide-spread desolation. The sinn-total did
not fall <-iiort oC JJIUO.OUO. before llic fiie, the gross
sales of the icadinjr wliolesalc diugf:ists amounted to
$'),(iOO,OOt) annually. Of the six wholesale druppists
wlio were entirely burned out, five have re--umcd busi-
ness and are transacting business with their usual de-
spatch.

A Vkuv Old Man.— Harvey Thncker, who died
recently in California, was one hundred and twenty-
eight years old at the (iate of death. He was tlic son-
in-law" of the famous Daniel Boone, the first settler in
Kentucky.

A Gift to the Kentucky Puhlic Librarv. — Dr.
Christopher Graham, one of the oldest and most es-
teemed citizens of Kentucky, lias presented to the
public library of that State his collection of minerals,
fossils, and geological specimens, valued at $30,000, the
work of fifty years.

TiiK Laugest Consulting Practice in the Would. —
Dr. Gull, of Guy's Hospital, London, is said to have the
largest consulting practice of any phy.^ician in the world
—worth not less than £25,000 a year ($ll>5,000j.

LoNGEViTV OF FARMERS. — According to Dr. Nathan
Allen, of Mass., in his registration report of dcatlus in
that State for thirty years, tlie cultivators of the earth
stand as a class at the head, reaching, on an average,
the age of nearly G5 years.

Value of Salt. — In Africa the liigh-caste children
suck rock-salt as if it were suga", aUhougli the poorer
classes of natives cannot indulge their palates. Hence
the expression in vogue amongst them, " He eats salt
with his victuals," signifying that the person alluded to
is an opulent man. In those countries where mineral
salt is not procurable, and where tlie inhabitants are
far removed from the sea, a kind of saline powder is
prepared from certain vegetable products to serve in its
stead. Indeed, so highly is salt valued in some places,
that from its very scarcity it is employed as asubstitute
for money.— Food Journal.

Nationalities Relieved in Chicago, III. — "We learn
from the First Special Report of the Chicago Relief and
Aid Society, that the sufferers by the fire were of all
nationalities; and of 18,478 families who needed suc-
cor, 1,985 only were of native birth. The number of
Irish families' was 5,512; German, 7,280; Scandina-
vian, 2,104; English, 599; Scotch, 195; French, 185;
Italian, 112; Bohemian, 208; African, 241; Canadian,
94 ; Polish, 90. Ten other nationalities were represent-
ed. Up to Nov. 30, 1871, only one death occurred
among a population of 5,000 in barracks.

The Treasurer, Geo. M. Pullman, reports the receipt of
$2,485,884.55 up to November 18th, inclusive — of which
$493,4G0.3G had been judiciously distributed, leaving a
balance in sixteen different banks of $1,190,424.19,
drawing five per cent, interest. The officers of this
Society, incorporated February IG, 1857, are men of
high standing, and are entitledto the confidence of the
cora-nunity. Since this Report was written avc learn
that the aaiount received up to January Gth, was $3-
335,700. The balance on February 3d was $1,314,G29.

The Roosevelt Hospital, New York. — The Trustees
of this new Institution have published the learned ad-
dress by Thomas E. Vermilye, D.D., LL.D., made at
its opening, Nov. 2, 1871 — with opening address by

Edward Delafield, M.I)., the President. Interesting sta-
tistics are given, in which he mentions that physicians
and surgeons were first established in Infirmaries in
1437. The Knights of St. John opened a lio.spital for
sick pilgrims at Jerusalem in 1048, and were styled
Kniglits Hospitallers. There were hospitals for the
sick at Constantinople in the eleventh century. They
sprang then from the bosom of Christianity.

Death of Dr. Bulklev. — Resolved, That in the
death of Dr. Henry D. Bnlkley, the Medical Board of
the Nursery and Child's Hospital have to deplore the
loss of one of the earliest officers of the institution —
a member of its consulting staff since its organization.

Resolved, That the clo.se of his long life of usefiil-
ness is covered with honor, and that his memory will
be cherished by his former colleagues in this Board, in
common with all who were associated with him, know-
ing the inestimable worth of his private life, and the
eminent skill and spotless integrity of his professional
career.

Resolved, That a copy of these resolutions be sent
to the family of the deceased, to whom we tender our
warmest sympathy, and that they be published in the
medical journals of this city.

T. M. Markoe, M.D., > ^ _ ...
T T TT ^r V^ r Committee.

J. J. Hull, M.D., (

S.MALL-i'OX. — The cases of small-pox in this city
average the same — from seventy-five to eighty weekly.
In Philadelphia the number is somewhat decreased, as
is also the case in Boston and Chicago. The large
towns throughout the State are beginning to develop
the disease. Especially is this the case along the lines
of our railroads.

Academy of Medicine of Paris. — On account of
the deaths of Drs. Poiseville, Fabret, Dan3'an, Leblanc,
and Blache, five vacancies exist in the various sections
of the Paris Academy of Medicine.

Professor Huxley. — This distinguished savant will
absent himself from England for the next two or three
months — his health having given way. He will reside
during this time in Egypt.

King's College, London. — Dr. Priestley, of this Lon-
don medical college, has resigned the professorship of
obstetric medicine and physician for diseases of
women. He has lectured on widwifery for the last
fifteen years in this institution.

Deaths of London Practitioners. — Robert Wade,
F.R.C.S., who has left important papers and works on
stricture of the urethra, recently was seized with a fit
of paralysis, and died .shortly afterwards.

Dr. J. Charles Hunter, L.R.C.P., formerly an in-
spector of vaccinators to the National Vaccine Institu-
tion, died December 19, 1871, act. 72.

Rush ^Medical College, Chicago. — At the twenty-
ninth annual commencement of this college — held
January 17, 1872 — there were seventy-seven graduates.

A New Monthly Medical Journal, called L' Union
MidicaJe du Canada, has made its appearance in Mon-
treal, edited by J. P. Rottot, M.D., with A. Dagenais,
M.D., and L. J. P. Desrosiers, M.D., as assistants, and
contains about fifty pages of the matter usually found
in journals of that size; the principal article in the
first number being devoted to a discussion of " The
New Medical Bill," and of the question of " Medical
Reform."

THE MEDICAL RECORD.

©rigtital Communications.

TWO CASES, ILLUSTRATING THE PRO-
DUCTION OF VOWEL AND CONSONANT
SOUNDS.

By Pkof. E. M. MOORE, M.D.,

ROCHESTER, N. Y.

The function of voice has always been a theme of inter-
est to a wider circle of men than pliysicians. The most
profound students of language, those who push their
inquiries into the phonetic forms of the dim past, seek-
ing to unravel the net of histor}"- in the twilight of the
race, are perhaps more interested than any other class,
except the ]iure physiologist. The students of San-
skrit have brought forward elaborate and excellent
treatises upon phonation, written more than three
thousand years ago, pushing the inquiry as far and as
accurately as mere observation could go. Since the
discovery of the lar3'ngoscope tlie whole subject has
undergone and is now undergoing a complete revision
by the practice of auto-laryngoscopy, and we shall
undoubtedly have the whole topic vastly advanced.
Indeed it may be so far as to enable us successfully to
initiate an inquiry into an anatomical explanation of
certain phonetic laws which some profound German
scholars have propounded, and also lead to the discov-
ery of others. Tliese men look to the physiologists, in
hopes that a law of anatomical and physiological rela-
tion to sounds may be discovered, upon whii.'h to rest a
solid foundation for the expansion of ethnology and
L'omparative philology.

The unanimity of opinion among physiologists, who
have given their attention to the function of the larynx
in the production of the voice, has led me to note two
cases of striking interest, and so conclusive in their
character that I think they will be regarded as an off-
set to the experiments and observations that have
heretofore been made, and upon Avhich opinion has
rested. They have the merit of substituting fact for
inference, and, indeed, fact bearing the potency of an
experimentum crucis. In order, however, to the full
understanding of the question, I will take Carpenter as
the authority for the standard opinions, and recite his
view on the subject at the point I propos3 to eluci-
date.

The doctrine of the reed-sound in the production of
the larjmgeal voice, it seems to me, is firmly settled
and universally admitted; the proof resting not only
upon the form of the organ, but on the production of
sound from the artificial larynx. Here at the vocal
chords, the body of sound known as the sonant voice,
in contradistinction to the whisper, is undoubtedly
made. But the especial point to which this paper is
directed is not this, but to the correction of opinion
with reference to the production of vowel-sounds.
These are asseverated to result from the passage of air
along the mouth, and to be the effect of its modifica-
tion, including, of course, the pharynx and nose as fac-
tors. In proof of this I quote Carpenter.

"The vowel-sounds are continuous tones modified
by the form of the aperture through which they pass
out; while in sounding consonants the breath suffers a
more or less complete interruption in its passage
through parts anterior to the larynx. Hence the really
simple vowel-sounds are capable of prolongation during
any time that breath can sustain them. This is not
the case, however, with the real diphthongal sounds (of
which it will presently appear that the English i is one).

whilst it is true of some consonants. It seems to have
been forgotten by many who have written on this sub-
ject, that the laryngeal voice is not essential to the
formation of either vowels or consonants; for all may
be sounded in a whisper. It is evident, therefore, that
the larynx is not primarily concerned in their produc-
tion, and this has been fully established."

Again he says: "That the vowel-sounds are pro-
duced by simple modifications in the form of the exter-
nal passages is easily proved, both by observation and
imitative experiment. When the mouth is opened
wide, the tongue depressed, and the velum palati elevat-
ed, so as to give the freest pO:sible exit to the voice, the
vowel a in its broadest form (ah) is sounded. On the
other hand, if the oral aperture be contracted, the
tongue being still depressed, the sound oo, the continen-
tal M, is produced. If attention be paid to the state of
the buccal cavity during the pronunciation of the dif-
ferent vowel-sounds, it will be found to undergo a great
variety of modifications, arising from varieties of posi-
tion of the tongue, the cheeks, the lips, and the velum
palati. The position of the tongue is, indeed, one of
the primary conditions of the variation of the sounds,
for it may be easily ascertained that, by peculiar inflec-
tions of this organ, a great diversity of vowel-sounds
may be produced ; the other parts remaining the same.
Still there is a certain position of all the parts which
is most favorable to the formation of each of these
sounds; but this could not be expressed without a
lengthened description. The following table, slightly
altered from that of Kempelen, expresses the relative
dimensions of the buccal cavity and of the oral orifice^
for some of the principal of these — the number 5 ex-
pressing the largest size, and the others in like propor-
tion : —

Size of
Yuwel sounds. Oral opening. Buccal cavity.

a as in ah 5 5

a " name 4 2

e " theme 3 1

" cold 2 4

00 " cool 1 5

" These are the sounds of the five vowels, a, e, i, o, ?/,
in most continental languages ; and it cannot but be
admitted that the arrangement is a much more natural
one than that of our own vowel-series." Having
made this quotation, I proceed at once to give the first
case, bearing directly on this point : —

Edward Larkin, tet. 50, born in Ireland, April 14,
1871, attempted suicide with a razor. A cut was made
immediately above the thj'roid cartilage, extending an
inch each side of the median line horizontally, and
shaving off the epiglottis at its base. The muscles be-
low and above, by their tonic power, soon made an
oval opening, two inches by | of an inch. Swallow-
ing became impossible. On the fourth day he was
brought to St. Mary's Hospital, having taken no food.
No attempt was made to bring the edges together, trust-
ing to the granulating process. A tube, introduced
through the opening into the oesophagus, conveyed
food to the stomach. This process was continued for
about five weeks, when swallowing became possible,
although the opening, which had become nearly circu-
lar, was about half an inch in diameter. At the present
time (June 10, 1871) he swallows solid food, but part of
the liquid food will run out of tlie opening. At any
time he was able to talk by bending his head forward
and temporarily closing the opening. When the head
was thrown back, he immediately lost this power.

The experiment of enunciation of the alphabetical
sounds, with the head thrown back, was made with the
vowels first. The four sounds of a as in all^ arm, age,

THE MEDECAL RECORD.

at, were at once disi inctly rendered. F, next attempted,
alwnys resulted in n as in uije. (This, I tliink, must be
jmt to the ni'counl of tlio llibeniian larynx.)

y is a (liphthong, and was ck-arly reniltTod.

O, botii long and sliort, was well brought out as in
note and not. The short u as in cut, and represented
by nearly all the other vowels, was also well pronounced.

}' as /.

The diphthongs were more difficult, and some could
not be uttered ; 01/ as in onr was pretty well pronounced ;
00, a pure vowel, was uniformly rendered as o in note.

Oi, as in noise, could scarcely bo distinguished.

The alphabet, taken in order, resulted in the enun-
ciation of the vowel element. Thus our letter Ji was
pronounced a, as also C and A There was absolutely
no consonant uttered. The breathing, which is repre-
sented by the letter //, was perfectly rendered. It was
clear and smooth, and when joined to a vowel was
spoken loudly and clearly. Thus, J/a and other sounds
of(f, III and IIo, tilso Jin short, -wove i)ronounced with
ease. A' and O' arc considered guttural aspirates. Any
attempt to produce them resulted in the pure aspirate.

These experiments were repeated on two difierent
occasions, a few days apart, and with the same results.
But on the second trial it was suggested that some air
might pass into the mouth, and a curtain of buckskin
was iitted to the upper part of the aperture, thus cut-
ting off all the air that might reach the mouth. The
result was the same.

As regards the finish of the tones called vowels,
there was clearly a defect. This might be due to the
thickening of the mucous membrane, incident to the in-
flammation in its immediate neighborhood — a good and
quite sufficient cause. Or it might be explained by
the absence of the modification by the mouth, tongue,
and other parts, which have been supposed to create
the sounds, but which, as is here shown, can only polisii
and comj)lete what has been begun. But a little prac-
tice will enable one to hold the parts above the larynx
perfectly quiet, and still produce the vowel-sound.
This case is so pathognomonic, if I can apply such a term,
that it must reverse and settle opinion upon the seat of
certain vowe'-30unds.

The number of sounds that Larkin was able to enun-
ciate is limited ; but I will now cite another case that,
from its peculiar character, supplements the one just
detailed, and by its results confirms the belief that
Larkin's ability to enunciate as described would exist
in all others, tims placing the seat of such vocalization
as normal in all.

During the year 1856 I Avas called into Orleans Co.
to see Edward Matthews, wlio was suflfering from ur-
gent dyspnoea. I arrived at his house in the night, and
at once opened the crico-thyroid space. The relief was
sufficient, and I did not see him again for a long time.
Two years after, as I am informed, a piece of bone was
removed from the opening, which had been kept free
by a tube. This seemed to be lodged in the larynx
somewhere, but the statement is too indelmite to be
thoroughly understood. Nevertheless, there was a
great abatement of unpleasant symptoms from soreness
and dy,«pnoca. But slowly and gradually the glottis
became closed, and for more than ten years a cicatrix
has cut off the air from the trachea into the mouth, the
closure being at the base of the larynx and absolute,
not the least air passing through. Mr. Matthews, who
is now forty-four years of age, is a man of intelligence,
and has made great and constant efforts to enunciate
clearly, and has improved much of latter years. Of
course, every sound is a whisper, and also short, for the
air ii driven by the buccinators and the muscles of the
tongue and the supply of air is small. From this man

we would expect to hear the consonnnis, if ho could
speak at all, and this is essentially true.

II and L he cannot jironounce, as they rc(iuirc a con-
tinuous tone, and are interested in a quiescent state of
tiie buccinators, wliich arc the chief means of forcing
the air out. JJut even these sounds can be faintly
traced in combination with others, in the con.vtruction
of a word. Tlie pure breathing represented liy the let-
ler II cannot be made at all, or in any combination.
The single vowel-sounds of a, as in arm, uf, all, and aye,
cannot be rendered at all. A blowing sound was the
result of the effort, and when the finger was placed
over the aperture in the trachea there was nb.solute
silence. The cerebral command was obviou.sIy to the
larynx. O was also silent, or resulting in 00, as in ooze.
/, as in isle, was also silent when the aperture was
closed, or a mere blowing sound if opened. 7i clearly
enunciated, and this vowel is made in the front part of
the mouth, by throwing the tip of the tonpue against
the lower incisors and curling it upwards. While fixed,
the continuous tone -f results.

The nameless vowel represented by u as in nut, e as
in err, i as in sir, and as in honor, sometimes styled
the nnvocal, could not be uttered except in connection
with consonants.
Short o as in not,
" e " net,
" i " nit,
could be rendered in conjunction with consonants, but,
with the exception of short e, could not be rendered
individually. The diphthongs were much more success-
fully pronounced than by Larkin.

Thus the soft u as in fjratitnde is a diphthong com-
posed of e w (00) and was rendered beautifully.

Oo'is really a very pure vowel, perhaps the most of
any, if we except e, but it is not so placed in our cata-
logues, and I can hardly understand why, unless it
happens to be represented by a double character. This
is made at the lips exclusively, as in ooze, and was ren-
dered with great perfection.

Oi as in noise, and ou as in our, both failed.
As might be expected, the consonants are generally
pronounced, most of them individually, but some only
in connection with voweL^.

B, C, D, F, G, K, P, T, X, Z, and V, pronounced as
words and pure. But H not all. L and R very faint,
when combined with e long.
M and N in connection with vowels only.
The consonants, P and T, made in the front part of
the mouth, were more easily managed than the others.
Accordingly the vowels within his capacity were sure
to be brought out best between them. Thus: —

Pet 1 Pretty well.

Pit " "

Pot " "

Put " "

Peet Admirably.

Pout Not at nil".

Pent Beautifully. .

Pat as Put or Pot.

Pate, not at all, or as Peet.

Th, as in Thing and With Well.

Ch, as in Church, and Sh, as in Shall. . .Well.

Nt, as in Se7it Well.

The conclusions that I arrive at from these two
striking cases are these : —

1st. That the larynx is not only the generator of
voice (so called), but the actual seat of vocalization for
the vowels a, in all its forms, i long, long, and the
pure aspirate. Also the short vowels, which are also
explosive, as i in sit, in not, and nameless one or
unvocal.

THE MEDICAL RECORD.

2el. That these sounds receive a finisli in the pha-
rynx, nose, and mouth ; with the exception of tlie pure
breathing and the short vowels.

3d. The consonants are all made above the larynx.

4th. The vowel e long is made purely in the front
part of the mouth, also the vowel oo and the diphthong
e«, which is composed of these two elements.

5th. The short vowels (e in met) (i in sit) (u in nut)
(o in not) can be made in the front part of the mouth.

6th. The unvocal can probably be made in several
places from the larynx to the front of the mouth.

These propositions are nearly all mere statements of
facts, but some are inferences.

The observations on Edward Larkin were made in
the presence of my colleagues Drs. Casey and Carroll
of Sr. Mary's Hospital, and also of Prof Lattimore of
the Rochester University. They were repeated on
two occasions, a few days apart, but became afier a
short time impossible from closure.

Those on Mr. Matthews have been repeated on three
occasion?, within the last three months: on cne in the
presence of my colleagues in the Buffalo Medical Col-
lege and several physicians and students of medicine,
and on another, in the presence of Prof Mixer of the
Rochester University, and Prof Palmer of the Normal
School at Brockport — two gentlemen whose inteivst in
the case arose from the fact that they were the teachers
of languages in their respective institutions. Doubtful
sounds have been carefully excluded, and I feel sure
that no observations have been retained which are not
clear and decided beyond cavil.

CASES OF CEREBRO-SPINAL MENIN-
GITIS.
By JOHN DWYER, M.D.,

RESIDENT SCnGEON NEW YORK STATE EMIGRANTS' HOSPITAL, WARD'S
ISLAND, N. Y.

The following notes of six cases, typical of thirty cases
of cerebro-spinal meningitis, treated in the Emigrants'
Hospital during the years 1870 and 1871, may be of
interest in connection with an inquiry made at a late
meeting of the County Medical Society, "Whether any
member had at present a case of cerebro-spinal menin-
gitis under observation ? "

Case 1. — Mary McG., aged IG, previously a strong
healthy girl, living in a private residence on the Island,
was rather suddenly attacked on 9th February, 1871,
with a chill and headache which increased during the
night; first saw her at 11 a.m. on the 10th, and found
her shivering, complaining of acute pain in right frontal
region, also in the lumbar region ; she was vomiting
freely a yellowish-white matter. At 6 p.m. she was
visibly worse, although vomiting had ceased and a solu-
tion of quinine was retained in her stomach ; complained
of intense pain in forehead and occiput, neck arched
backwards, surface and extremities cold. She was
screaming out for relief, had a wild look in the
eyes, and she rolled restlessly about the bed, striking
her head against the pillow. She was partly delirious.
At 8 P.M. tiie right pupil was insensible to Hght, right
foot and hand slightly convulsed. She suddenly began
to sink, and died comatose a little after midnight, about
thirty six hours from the attack. No post-mortem could
be obtained.

Case 2. — Peter Samelsen, aged 32, engaged in out-
door work, suddenly attacked on 13th February, four
days after case No. 1, with chills, prostration, and in-
tense headache; did not speak after admission to hos-
pital, moaned heavily, head and neck bent stiffly back-
wards, vomited freely ; died comatose 36 hours after

admission. Post-mortem revealed acute meningitis and
profuse serous effusion of the arachnoid on the upper
anterior surface of the right hemisphere of the enceph-
alon. The lungs were oodematous and the spleen en-
larged.

Case 3. — Pelagius Cremer, aged 39, engaged in out-
door work, attacked on same day and in same manner
as preceding case ; died in thirty hours. Post-mortem —
acute general meningitis, not marked in one locality as
in case No. 2 ; otlicr organs healthy, except a very much
enlarged spleen. It was reported that this man had
repeatedly suffered from intermittent fever.

Case 4. — Charles Grevcr, aged 24, in hospital with
periostitis of tibia, suddenly attacked with chills and
headache on 12th March, 1871 ; vomited freely yel-
lowish matters; skin cold, pulse not extraordinary.
Quinine Avas given which was retained, and seemed to
restrain the vomiting. Under the influence of chloral
he dozed through the night, occasionally waking up,
moaning and tossing about restlessly in bed. On the
13th he was worse, complained of terrible pain in fore-
head, neck, and back ; the muscles of abdomen became
rigidly tetanic, and opisthotonos set in. The skin was
mottled darkly, and there was an indistinctly marked
purpuric appearance; he had a slight convulsion, and
passed urine and fteces in bed ; he slept occasionally,
raved and breathed stertorously, frothing at the mouth.
Commenced to sink early on the 14th, and died forty-
seven hours from attack. Post-mortem : Calvarium
unusually thin, dura mater much congested ; on de-
taching dura mater the whole surface of encephalon
was bathed in bloody serum floating small jelly-like
particles of lymph ; the pons varolii and medulla ob-
longata were profusely charged with serous effusion ;
other organs healthy.

Case 6. — Recover3^ Patrick S., aged 10, residing in
a detached house near the farm. Deep excavations for
buildings have been going on in tiie immediate vicinity.
He Avas suddenly attacked, on February 12, 1871, with
headache, chills, and vomiting, as in preceding cases.
On the 13th his breast and face mottled darkly, but not
spotted; abdominal muscles rigid, neck and spine bent
backwards, herpetic eruption on face and lips ; this child
suffered great pain and was delirious at intervals, rolling
about uneasily in bed, and stretching out his arms ri-
gidly. About the tenth day the right eye became in-
flamed, and an opaque effusion appeared in the anterior
chamber. The pupil was kept well diluted with atro-
pine, but seemed insensible to light ; he was also a little
deaf The eflfusion daily became more opaque and solid ;
the boy suffered severely, continually complaining of his
head ; but fighting through all the phases of the disease,
he began to improve about the sixth week, but was
unable to leave his bed before the expiration of the
ninth week. The herpetic eruption and the effusion in
sheath of the optic nerve left no doubt of this being a
true case of cerebro-spinal meningitis.

He still resides on the island, and his condition at
present, one year since his sickness, is as follows :
Right eye atrophic, vision completely lost, anterior
synechia, pupillary space contracted, and filled up with
a lymphic white deposit; partial but apparently perma-
nent paralysis of right side, throws out the right foot
and hand with an uncertain motion ; occasionally com-
plains of headache; hearing not good.

Case 6. — Recovery. Teresa S., aged 4, sister of
case No. 5, attacked on Feb. 23, eleven days after, and
in the same manner as her brother ; opisthotonos ex-
isted to a degree, swallowed with difficulty ; suffered
severely with headache, and moaned incessantly ;
shrieked when her neck or occiput was touched ; when
lifted by her mother she continued rigidly bent back-

THE MEDICAL RECORD.

wards ; the tongue always kept dry and chippy ; the
Hps and face also spotted with herpes; she was for
some time deaf while sick, but the eye did not suffer.
Althoufjh ihis child wa^ an aggravated case, she re-
covered three weeks before her brother, and she now
siiows no evidence of any cerebral lesion, being ap-
parenily quite heallhy.

During 1870 only four cases of cerebro-spinal me-
ningitis occurred in the hospital, all resulting in death.
Shiirtest duration of disease three days.

During 1871 there were 26 cases treated, of which
li died: 1 died in eighteen hours from attack; 5 died
within two d.iys, 3 within ten days, 1 within thirteen
days, and 4 exceeded this up to eight weeks, the re-
maining 12 becoming clironic, made a protracted re-
covery.

In the month of January, 1872, already two fatal
cas;;s have occurred: one died in twenty-two hours, and
the other in eight days.

There was no peculiarity to be observed in the ages
of those attacked; the majority were adults, four were
under ten years of age.

Of the whole, only four were females. Winter or
summer did not seem to make any diflerence, the cases
in each season being about equally divided, except
that in February, 1871, five cases occurred wiihin a
few days of each other.

With the exception of cases 5 and 6, there was little
or no communication between the parties attacked, the
cases were scattered through the different buildings of
the institution.

Strict attention is paid to the sanitary condition of
the whole institution, Hospital and Refuge, and no
local cause could be discovered as the exciting one,
unless the turning up of fresh ground for the buildings
i 1 progress might indicate its malarious character.

men had been exerted to their utmost. Now for my
plan:

I place the patient upon a common chair. I pass
around his body, below the arms, a bmad strong towel,
the ends of wliich I give to a stout assistant. The next
step, ami tlie most important of all, is to fiindy fix the
scapula. Without tins precaution you will Ijc pretty
sure to fail, pull as hard and as long as you plea.se. To
fix the scapula I direct one intelligent a'-si-tant to place
the ball of the hand firmly against the acromion process.
I then tie a handkerchief around the arm direc'ly above
tlie condyles, and make in it a loop for my right hand,
then, with the arm hanging down closely to the body,
I pull gently and steadily directly downward:*, and, with
my lelt hand in the axilla, the bone slips ea-ily and
quickly into place. Now in this dislocation the head of
the bone lies under and in contact with the neck of
the scapula, and if by any means you can depress the
head of the bone to the extent of one-eighth of an inch,
or even less, there is nothing to prevent your glidini;
the bone easily into place, and that, too, without injur-
ing any of the joint structures. I have said that I claim
this method as exclusively my own. If it has ever been
practised or recommended by others, I have failed to
see it.

THE "ARTERY CONSTRICTOR," WITH
CASES.

By S. FLEET SPEIR, M.D.,

BKOOKLYN, N. T.

(Rcml before the Medical Library and Journal Assuciation, N. Y.)

A NEW METHOD OF REDUCING A DISLO-
CATION OF THE HU:\IERUS INTO THE
AXILLA, WITH REFERENCE TO THE
ANATOMY OF THE SHOULDER-JOINT.

Bt E. p. BENNETT, M.D.,

DAXBUBT, CON'S.

Ix the early part of my professional life, being often
called upon to reduce this very common dislocation, I
often experienced great difficulty in accomplishing my
object, and when I did succeed I often found irrepara-
ble injury had been done to the structure of the joint,
and the patient more or less crippled. I carefully
studied all my surgical works, and carefully examined
and tried all of the various methods by them advised
for the reduction of this injury, and finally came to the
conclusion that they were all radically defective, as
they did not take into consideration the anatomical
structure of the joint. It is needless for me to detail
these various methods, as they are famihar to all, and,
as I said before, they are all unscientific and defective.
It does seem as if in most of them the efforts of the sur-
geon and of his assistants were designed more to tear
the scapula from its attachments to the chest, and the
muscles from their attachments to the humerus, than to
replace the displaced bone. Since I have adopted
my method, which I call the anatomical method, and
which, egotistic as it may appear, I claim as exclusively
my own, I have never failed in a single instance of re-
ducing this dislocation by the tractive force of one hand,
and this after all the other methods had been tried and
failed, and when the united strength of ten or twelve

' CONS'TRICTION'

OF THE ASTERIOR TIBIAL AND INTERNAL
PLANTAR ARTERIES.

Case I. This is the only case in which there has been
any accident after the application of the artery con-
strictor, under my observation; and as a faithful
record requires the whole truth to be told, I am glad I
have nothing worse to report.

On tlie 28th of December, 1870, at the Brooklyn
City Hospital, Dr. D. E. Kissam, performed amputa-
tion at the ankle-joint, on a woman aged 30 years,
for extensive disease of the bones of the foot. The
patient was etherized, and Pirigoff's operation perform-
ed. At the invitation of Dr. Kissam, I closed the ante-
rior tibial artery with the constrictor. This was the
onl)' arter}' which bled at the time of the operation, and
it was supposed that the other arteries had been closed
by the previous disease and inflammation ; however, tl:e
internal plantar artery looking larger than usual, it was
thought best to apply the constrictor to it also; which
was done before closing the wound. In coaptating the
flaps, it was found tiiat considerable force was neces-
sary to overcome the resistance of the muscle, and
adjust the portion of the os calcis (which is left, in
this operation), to the ends of the tibia and fibula. In
doing this, Dr. Kissam jiressed very violently upon the
anterior tibial artery, at the point where it had just
been constricted, and repeated this pressure several
times before he was able to adjust the bones. Not-
withstanding which, there was no bleeding from the
artery. I was in some doubt as to the propriety of
leaving the vessel in this condition without reapplying
the constrictor, in order to replace the invagination of
the internal and middle coats, which it seemed to me
must have been turned back, and perhaps the clot dis-
lodged by this violence ; however, as there was no
bleeding from the vessel, and all present appearing
satisfied with the security of the artery, it was left as

THE MEDICAL RECORD.

it was, and the wound was closed by silver sutures,
one of which was passed, as it seemed to me, right
through the anterior tibial artery (an accident which
might very easily occur, as there was no guide to the
artery), and my anxiety for the integrity of the vessel
was again aroused; slill, no bleeding following, the
stump was bandaged, and (he patient put to bed.

At 8 P.M. the same night there was bleeding from
the stump. Dr. Hamilton, the House Surgeon, found it
necessary, in order to nri-est the hemorrhage, to open
the wound. He found the anterior tibial, which had
been constricted, bleeding; he tied this vessel back of
the constriction. This, however, did not arrest the
bleeding, and the external plantar artery was sought
and tied; this checked the bleeding sufficiently to leave
it for the night, and Dr. Kissam was notified. I went
with him to see the patient the next morning. We
found that there were yet several small vessels which
continued to bleed. Their texture was such that a
ligature applied to them cut completely through them,
and came off at once, — so that it was very difficult to
check the hemonhage, but by great care we finally
arrested it. The internal plantar artery, which had
been closed by the constrictor was sought, and it was
found to be perfectly closed with a firm clot, no bleed-
ing having occurred from it. In fact, it was about the
only vessel in the wound which did not bleed.

POPLITEAL ANEURISM TREATED BY THE APPLICATION OF

THE " ARTERY CONSTRICTOR " TO THE FEMORAL

ARTERY.

Wm. L , a cachectic mulatto, aged 50 years,

was admitted to the Brooklyn City Hospital, August
4, 1871, under care of Dr. D. E. Kissam. In March
last, while descending a flight of stairs, the patient slip-
ped and wrenched his left leg, which gave him at the
time some pain about the knee. The following day
the pain was so great that he could not bend his knee.
In a short time the pain diminished, and he could walk
pretty well. Early in June he noticed a tumor in the
popliteal region, and at that time he had pain in
his foot, and a feeling of numbness in his leg and
foot. Since the first of July, he has had sharp darting
pains in the tumor. The following is the history as
taken by Dr. Balch (Resident) : On admission he can
extend his leg perfectly, but he cannot flex it com-
pletely ; there is a tumor the size of an orange situated
in the popliteal space ; palpation gives distinct pulsa-
tion in the tumor, and a decided thrill ; auscultation
gives a well-marked " bruit." Pressure on the femoral
artery stops the pulsation, and the tumor is then easily
emptied ; stop the pressure, and it immediately refills.

Auf/unt bth. — Treatment was commenced by the ap-
plication of Dupuytren's Pad to the femoral arterj' ; at
the same time flexing the leg on the thigh, a bandage
was applied from the toes up to the knee. This ap-
paratus remained on till August 17th, at which time
the tumor was considerabl}^ harder, but the patient
would not submit to the apparatus any longer, as he
said it gave him too much pain. The leg was then
kept flexed on the thigh till August 2Gth, when, no
further progress being made towards a cure, Dr. Kis-
sam invited me to apply the artery constrictor to the
femoral artery. Dr. Kissam made an incision about
14- inches long in Scarpa's space, and found the artery
very superficial. The sheatli of the artery was opened,
and I applied the artery constrictor to the vessel, and
immediately all pulsation in the tumor ceased. The
wound was closed with silver sutures and adhesive
straps, and picked lint, dipped in a weak solution of
carbolic acid, placed over all, and the leg enveloped in
cotton wadding, and the patient put to bed. In the

evening the temperature of the foot and leg was higher
than that of the sound limb ; there was verj'' little pain ;
pulse 92.

AiKjTist 21th. — Rested pretty well last night; wound
looks healthy; no pain ; no numbness.

Aiirjvst 2Sth. — Wound begins to suppurate ; pulse 84 ;
some fever; complains of numbness; temperature of
foot good. August 2dth. — No fever; pulse 80 ; tongue a
little coated ; sutures removed, and wound dressed with
weak solution of carbolic acid, and adhesive plaster ;
some suppuration. Avgust 30tJi. — Wound suppurating
freely ; no union by first intention. September 3d. — Not
so much suppuration ; Temperature of foot normal.
Srpiemher Blh. — Wound begins to heal ; removed wad-
ding from the leg; temperature of the leg normal;
aneurism smaller. September Wth. — Wound nearly
healed ; patient looking well ; no pain or numbness.

September '?.hth . — Wound entirely healed ; patient can
nearly straighten his leg, can flex and extend his foot
without any trouble. October 5tJi. — Discharged from
Hospital, cured.

The immediate relief from pain which followed the
application of the constrictor was in marked contrast
with the great distress and pain attending the treat-
ment by compression and flexion.

AMPUTATION OF THE FOREARM WITH APPLICATION OF THE
" ARTERY CONSTRICTOR."

Christian S , set. 39, admitted to th.e Brooklyn

City Hospital August 7, 1871. This patient, while at
work in his shop, had his wrist caught between two
wheels, producing a badly-lacerated wound of the dor-
sal aspect of the liand, compound dislocation of lower
end of radius, compound fracture of the styloid process
of ulna, and crushing of the carpal bones. The parts
above the wrist were uninjured. I saw the patient at
one P.M. He was then etherized, and I amputated the
forearm at its lower third, by dorsal and palmar flaps.
The artery constrictor was applied to the ulnar artery,
the radial and interosseous arteiies were secured by silk
ligatures, the flaps broughtjtogether by Avire sutures, and
dressed with lint soaked in a solution of carb(»lic acid
and water ; patient put to bed, arm at rest and elevated
upon a pillow, and an opiate at night.

Sth. Patient feels very weak (probably due to loss of
blood before operation) ; pulse 120 ; has pain in stump ;
ordered an opiate ; vomited after breakfast to-day. dtJi.
Pulse 110 ; stump looks well ; suppurating where the
ligatures were applied, no .mppiiration on side where the
constrictor was used. 10!"/;. Pulee 105, suppuration con-
fined to the radial side. i2fJi. Feels better ; pulse 100 ;
sat up in bed to day. 15;!/?. Removed sutures. The
flaps on the ulnar side of arm have entirely, healed by
first intention; on radial side suppuration continues.
17^/;. One of the ligatures came away to-day. 20th.
Patient went out on pass to day, still suppurating at
point of radial hgature. This ligature remained in the
stump until September 29th. October 12fh. The wound
has entirely healed, and the patient is discharged from
the hospital, well.

AMPUTATION OF THE LEG WITH APPLICATION OF THE
ARTERY CONSTRICTOR.

Thomas T , fet. 40, was admitted to the Brooklyn

City Hospital August 17, 1871; service of Dr. D.
E. Kissam. The Ibllowing history is furnished by Dr.
Rushmore (Resident): While at work on the East
River Bridge, the patient's ankle was caught by a coil
of rope in motion. He was knocked doAvn and his leg
severely injured. He was brought to the Hospital im-
mediately, and there was found a lacerated wound on
the inner side of the tibia, at the lower end. The inter-

THE MEDICAL RECORD.

nnl malleolus nl^o fractured. The foot was everted, the
plantar aspect being parallel with the outer aspect of
llio iofr. The posttTJor tibial arlory was uninjured; no
laceration of soft parts above the wound; but little loss
of Mood. The accident happened about 7 a.m.; at
10.30 A.M. the patient was anaesthetized, the malleoli dis-
eected ouf. and the di.slooation reduced by Dr. Ki?8am,
with a view to save the foot, if possible. The edges of
the wound were drawn together by wire suture.'*, except
at the most depending part, where there was left an open-
ing for the disc!iar;jes. On the 10th the patient's gen-
eral condition was i)ad ; pulse 13'2, skin hot, foot cold;
sensation in the foot pood, no di.scharpe from wound;
inner side of leg and tliigh red, painful, and hot. At
2.30 P.M., after consultation, it was decided to amputate.
The patient was etherized, and Dr. Kissam anij)utatcd
below the knee by anterior and posterior flaps. The
soft parts on the inner side of leg at the point of ampu-
tation looked and smell unhealiliy. At the request of
Dr. Kissam 1 applied the "constrictor" to the anterior
t.bial and the posterior tibial arteries, which were the
vessels bleeding, and a!l hemorrhage was immediately
controlled. The stump wa.s united by wire sutures and
carbolic-acid dressing applied, patient put to bed and
ordered supporting and stimulating diet, and opiate at
night. Pyaemia set in on the 21st; he was delirious
during tiie night and part of the day. The integument
on the inner side of the thigh inflamed high up as the
groin. The stump very unhealtliy, had very little sup-
puration, which was thin and bad-smelling. Sloughing
.^pots formed, one over the tubercle of the tibia and ano-
tiier on external aspect of the thigh. 23d. The flaps
sloughed, especially on the inner side and in front. 25th.
Patient died to-day.

The stump was examined, and the main artery was
found closed at the point of constriction. A few drops
of pinkish, thick, bad-smelling matter were found in the
vessel, but no clot. To the outer side of the larger
artery was a smaller one, lying close to the main artery.
This was constricted at a point corresponding to that
in the larger vessel, aud upon its invaginaled inner
coats was a clot which perfectly occluded the vessel.
There had been no hemorrhage from either vessel after
the operation. The absence of a clot in the larger ves-
sel seems to show that the invaginaled inner coats of
the artery were sufficient to perfectly close the ves-
sel

From the rough manner in which some of the "con-
strictors" that I have seen have come from the hands
of the instrument-makt?rs, it would appear that they
do not all understand the design of the instrument ; and
I wish to call attention to the fact that the constrictor
is not intended to have the effect of an ecraseur, but,
on the contrary, a blunt and smooth-linished surface
is very necessary. I would recommend to any one
who wi.shes to obtain the best result from the use of
this instrument, to pay special attention to this poiat:
every part of the surfiice which comes in cont.ict with
the artery must be polished, and great attention should
be paid to the edges of the sheath, to see that they are
,well rounded and smooth, — this is necessary to secure
the integrity of the external coat, more particularly so
when it is to be used in the treatment of aneurism.
Each constrictor should be tried on a piece of chamois-
skin or a fold of soft paper, or better still, an artery
from the " subject." If this is done, it can at once be
determined when the instrument is perfect. Every
instrument which " cuts through " should be discarded,
and only those should be accepted which constrict and
draw the paper, chamois-skin, or the artery, whichever
one is used, into the sheath, and allows of its being
pushed out again without breaking or cutting it. At

the same lime it must permit of a considerable degree
of constriction, and must not fit too loosely.

The size of the instrument used um.it be, to a certain
extent, adapted to the size of the artery to be closed.
In taking up small arteries in section, as in general
oj)eration.s, a very small constrictor should be used ; and
I have found that in such cases it is not nece.s.sary to
i-olate the vessel from the surrounding tissues before
constricting it, but they may be taken up with a tenac-
ulum or forceps, and constricted en masse. In constrict-
ing large arteries it is best to separa'.e the vessel some-
wliMt from the other ti-sues.

The length of time usually required in the application
of the artery constrictor for completing the clo.sure of a
vessel varies with the size of the vessel and the j)erfec-
tion of tlie particular constrictor used. In my own
cases it has varied from a single minute to several min-
utes. I usually leave it on the vessel only long enough
to thoroughly invaginate the inner coats, and then re-
move it, which would require for the whole operation
not more than one or two minutes. The work of the
constrictor may be considered done the moment a
complete invagination is accomplished. In the case of
aneurism it may be well to leave it on the vessel a little
longer, to secure a firm clot in the vessel before remov-
ing it, or even to control the circulation above the point
of application.

No constrictor should be used in an operation until
it has been tried upon a dead artery or on a piece of
chamois-skin or fold of soft paper, and its size and
peculiarities determined by actual trial; any imperfec-
tion will then be seen, and may be remedied by poUsh-
ing or filing down, as the case may require.

As soon as the instrument-makers learn exactly what
is required of the constrictor, they will, no doubt, be
able to furnish constrictors which will be perfect in
every respect when they leave the shop, and then these
precautionary measures will no longer be necessary.
Mr. Pfarre, of Tiemann & Co., has a thorough knowl-
edge of what is wanted in the instrument, and makes
some very good ones, and Avhen requested, will take
pains to adapt the constrictor to any sized artery de-
sired, or he will furnish them in sets of three or four
instruments of different sizes.

(DriaimU Cccturcs.

LECTURES ON OTOLOGY.

DELIVERED AT THE COLLEGE OF PHYSICIANS AND 30RGE0NS,
NEW YORK.

By Prof. H. KNAPP, M.D.
Repokted by Charles S. Turxbull, m.d.,

AS.SISTAST TO THE NEW YORK OPHTHALMIC AND ACBAL INSTITUTE.
THE ANATOMY OF THE MEMBRAN.^ TYMPANI.

Toe memb}-ana ti/wpani, or drum-head, separates the
external meatus from the tympanic cavity. It is set
in a groove upon a ridge at the tympanal termination
of the bony meatus. It is situated obliquely, its outer
surface being directed downward and forward.

Upon viewing the membrane, Ave distinguish the fol-
lowing details:* — In the centre of the upper portion a
white pointed elevation is conspicuous, — this is caused
by the short process of the hammer bone; from this a

^* The lecture was illustrated by drawings on the blackboard, anatomi-
cal specimens, and microscopic preparations.

THE MEDICAL KECOED.

ridge, formed by tlie manubrium mallei, runs downward
and slitjhtly backward, terminating in a navel-like
depression called the lonho membraniv hjmpani.

The area of the drum-head is best divided, according
to Sir Wilham Wilde, into an inferior, superior, anterior,
and posterior segments.

The inferior segment is defined by lines running at
right angles from tlie umbo forward and backward to
the periphery.

The superior segment presents itself as a purse-like,
flabby projection, the inferior boundary of which runs
horizontally from behind forward, with the short pro-
cess lying a little before its centre. On account of its
flabby pnd folded appearance, the superior segment of
the membrane is called the flaccid portion, or " 7nem-
hraiia flaccida ShrapnelUi." As the folds are directed
from the short process partly backward and partly for-
Avard, they are distinguished as posterior, and anterior
folds.

That part of the membrana tympani lying in front of
the manubrium mallei, between the anterior-superior
fold and inferior segment, is called the anterior seg-
ment, and is generally somewhat depressed.

In a similar way the p)osterior segment lies between
the handle of the malleus and the posterior portions of
the upper and lower segments.

At the junction of the anterior and inferior segments
a bright triangular speck, pointing towards the umbo, is
conspicuous on inspection with the mirror, and is pro-
duced by tlie pecuUar curvature of the membrane being
convex from the umbo to the periphery.

Tlic membrana tympani is of a pearly-gray color,
somewhat yellowish in the centre, on account of the sur-
face of the promontory shining through the translucent
membrane, the centre of which lies much nearer the
promontoiy than the periphery. It is winter at the peri-
phery, because there the circular fibres and the connec-
tive tissue continued from the neighboring parts to tire
membrane are more abundant than in any other part.
Upon considering the structure of the membrana tym-
pani we find it composed of tliree layers, divided as fol-
lows : first, the cutaneous, containing the dermoid and
sub-dermoid layers; second, the./?/j/-o».s layer, consisting
of radiating and circulating fibres; and third, the
raucous layer, containing the epithelial and sub-epithe-
lial layers. The fibrous layer is found devoid of both
blood-vessels and nerves, whilst the two others, being
continuations externally from the epidermis of the
meatus, and, internally from the lining mucous mem-
brane of the tympanum, are supplied with nerves, ves-
sels, connective tissue, and epithelium. The thinnest
portions of the membrane are about midway between
the end of the handle downward and forward in the
anterior portion, and downward and backward in the
posterior portion ; and it is in one or other of these po-
sitions that we generally find a perforation, whether
caused bj' accident or disease (Wilde).

The cutaneous layer is composed of all the essential
elements of the cutis, except glandy, and is made up of
several layers of epithelium, connective and elastic -
tissue, well supplied wiih vessels and nerves. The
sub-dermoid connective tissue is intimately connected
with the fibrous, and is densest at the periphery of the
membrane and along the manubrium. A band of
parallel fibres, two lines in breadth at its origin, descends
from above downward, and surrounds the manubrium,
and in it and the peripheral increase of connective
tissue the vascularity is greatest.

The fibrous layer is comiposed a) oi a radiating slra.lum
of fine fibrilte, with connective-tissue corpuscles between
them, which are spindle-shaped in their longitudinal
section, and round, with three or more offsets, in the

transverse section, being a nucleated system of nutiitive
canals, like that of the corneal substance; b) the tendi-
nous ring, which is situated near the insertion of the
membrane into the groove of the tympanic ring, consists
of irregularly interwoven fibres of connective tissue, and
belongs to both the radiating and circular strata; c) the
circular stratum, which, however, does not commence in
the immediate vicinity of the tympanic ring, is thickest
near the tendinous ring, and becomes thinner as it ap-
proaches the manubrium. Gruber has described fibres
descending like those of the sub-dermoid layer.

The mucous layer on the inner surface of the mem-
brana tympani is a part of the mucous membrane
lining the tympanic cavity, and is abundantly supplied
with vessels, but scantily with nerves. Its epithelium
consists of one layer of polygonal cells, which are not
ciliated. Gruber describes a dendritic, or dendroid fibrous
formation, Avhich begins in the fibrous layer, with a
broad base at the lower and posterior part of the
periphery, running obliquely upward toward the handle,
and lying with its upper offsets near the sub-mucous
layer. It is identic with the fibrous layer, which lies
between the circular fibres and the epithelium of the
inner side, described more recently, in Strieker's Histol-
ogy, by J. Kessel. It is densest in the centre of the
membrane around the handle, and divides into numerous
branches which communicate with one another, and in-
sert themselves finally into the tendinous ring at the
periphery. Some of these branches penetrate the layer
of circular fibres, and either terminate there or return
in their further cour.se on the posterior surface of the
fibrous stratum. This membrane, of a more or less
trabeculated appearance, constitutes the sub-mucous
stratum.

On the inner surface of the mucous membrane, and
especially upon the trabeculse of the sub-mucous
stratum, are found numerous villi, which have the
structure of the mucous membrane, and contain in their
axes a loop of a blood-vessel, and so constitute vascular
papillae.

Gruber represents the connection between the
handle and membrane as joint- like, and asserts that in
many specimens the handle shows at this place a thin
layer of cartilage upon its surfiice. Facing the handle
and short process, a cartilaginous formation is imbedded
in the substance of the membrana tympani, connected
with the handle very loosely on its surface by delicate
fibres, but more densely by a kind of capsule on its
edges. The manubrium is, however, more densely con-
nected with the cartilage, and he asserts that he has
found epithelial cells on the opposing surfaces of the
short process and cartilage, and that a synovia-like
fluid is found between the bones and the described for-
mation of cartilage (page 63 of his monograph on the
membrana tympani). Moos, Prussak, and others deny
this joint-like union between the membrana tympani
and the hammer bone, the fibres of the membrane
proper inserting themselves directly into the periosteum
or perichondrium.

The blood-vessels of tliC membrana tympani are de-
rived externally from the arteriaauricularis profunda — a
little branch of the internal maxillary. In its course it
descends from the upper wall, runs along the manu-
brium, and divides into radiating branches, which
anastomose with those of the tympanic ring at its
periphery. The capillaries collect into two venous
branches, which run alongside of the artery. Prussak
and J. Kessel described two venous plexuses which re-
ceive the blood from the outer layer of the membrana
tympani, the one running along the handle, and the
other in a circular direction around the periphery.

The internal vessels are derived from those of the

THE MEDICAL RECORD.

mucous membrane of the tympanum, " artoria tympnn-
ioa," till" ramifications of whicli arc numerous, forming
a den^e net-work of capillaries. The fibrous layer, or ,
membrana propria, was formerly considered as having
neither ve^si.ds nor nerve?, but J. Kessel says that
it is pervaded by a net-work of capillaries connecting
the blood-vessela of the outer layer wilii those of the
the inner layer. The capillaries of thn membrana tym-
pani have an arrangement similar to tliat of tlie blood-
vessels: three strata, the one belonging to tlio cuta-
neous, the next to the mucous layer of the membrane,
and a third connecting the two witli each other by
capillaries running through the membrana propria (J.
Kessel).

The nerves of the membrana lympani are supplied
externally from the tympanic nerve — a branch of thfi
" tempero-auricular," derived from the third branch of
the trigeminus. It descend sfrom the roof of the
meatus and courses brandling in the same direction as
the artery. According to Kessel, there are branches
running from the outer layer into the fibrous layer, in
which a part of them remain, dividing into more mi-
nute branches or twig-:; while another })art pass tlirough
it and communicate with the nerves of the mucou> lay-
er. Those found internally are scanty, and are trans-
parent, without medullar}' sheaths.

WOUNDS AND INJURIES OK THE MEMBn.\NA TYMl'ANI.

The causes tending to injure this delicate membrane
are quite numerous — penetrating instruments and
foreign bodies, by external force or violence, such
as fracture of the temporal bone, blows upon the side of
the head, falls, etc.; sudden concussions of air, as in
pertussis, loud, sharp reports from heavy pieces of
artillery.

Gruber says that the membrana tympani bears verv
high degrees of pressure (from four to five atmosplicres)
Without bursting. He thinks that only in membranes
previously diseased a rupture is liable to occur by sud-
den increase of atmospheric pressure. The bleedino' in
pertussis and other diseases is not always a symptom of
rupture of the membrane, as also the blood-vessels of
the conjunctiva and other membranes are very apt to
burst in this disease.

The si/)))p'oms are : —

Pain, mostly of an inter.se character, at the moment
of the rupture. Sometimes, however, no pain is felt.

Fainting, which may be repeated during the next
twtnty-four hours.

Convulsion.'} are very rare.

A loud noi.'ie or crash at the moment of the rupture,
caused by the fearing of tb.e fibres or the sudden pres-
sure upon tlie labyrinth. The noise persists for some
days, in most cases, but gradually dmiinishing in in-
tensity.

The hearing is impaired in ©very case where the mem-
brana tympani was normal before the accident, but it
may be improved in cases of diseased membrana tym-
pani, for then the membrane is no longer a septum
barring the entrance to the waves of sound, the latter
having immediate access to the stapes, and the mem-
brana tympani secundaria.

Jlyperacusis, or Sonophohia, in rare cases: some
noises or tones being very disagreeable.

Los>i of the faculty of determining the direction of sound.
Tliis symptom is not constant, and soon disappears.

Extravasation, covering the rent in an otherwise nor-
mal membrane.

A rent orjissure of oval or linear shape; at times the
dermoid and radiating layers retract more than the
inner layers, and a wound with terraced edges is
produced.

The prognosis of wounds and injuries to the mem-
brane is generally favorable. Wilde, however, ob-
serves : — '' It is remarkable that, while we experience
the greatest difficulty in keeping open a perforation
made with a surgical instrument, accidental openings
seldom close." This serves as an argviment in favor
of Gruber's statement, that the memi)rane was gen-
erally diseased before the perforation occurred.

The treatment is simple and can be readily given :
Do not syringe, but let the ear alone.

Cleanse the meatus with cotton, and insert into it a
light plug of cotton or wool to protect the membrane.

The healing in most ca~es takes place rapidly and
without inflammation. If the latter ensues, the symp-
toms are those of myringitis.

profircso of iHctilcal Science.

PnoTOPnoBiA IN Sightless Eyes. — A writer in the
Br. Med. Journal cites three or four cases in which
marked j'hotophobia remained after destruction of the
eyeball, following injuries, in which favorable prognos-
tications had been given by physicians in attendance ;
their opinions that sight would remain after inflamma-
tion had been subdued having been wrongly based
upon such persistent sensitiveness to light.

Lead Poisoning from Snuff. — Dr. Garrod reports an
interesting case of this nature, which had been caused
by snuflT which had been packed in lead, and refers to
several other cases of similar character. It appears
that when moist snuflF is enclosed in leaden cases, and
especially when subjected to the action of heat in
tropical' climates, it becomes intensely poisonous from
impregnation with the metal. He explains this as fol-
lows: — Tlie moisture of the snufl', containing its solu-
ble salts, is evaporated and condensed on the sides of
the leaden case, upon which it slowly acts ; and the
lead salts, thus brought into solution, gradually impreg-
nate the mass.

Albuminuric Retinitis. — Mr. Swauzy, speaking of
this aflFection, says {Med. Press and Circular) : '' Every
one who has busied himself specially with diseases
of the eye must have had frequent occasion to diagnos-
ticate Bright's disease by the opthalmoscopic appear-
ances, while, as yet, there were no other prominent
symptoms ;" the disturbance of the function of the eye
being the first thing which would lead the patient to
seek medical advice. He thinks the physician who
takes the trouble to learn the use of this instrument
will be abundantly paid, during his first five years' prac-
tice, in his ability to use it as a means of diagnosis in
this afl*ection alone. He says that " as a general rule,
in those cases where the eye gives the first indication
of the presence of Bright's disease, the progress of the
latter is fiom that time very rapid. From three to six
or eight weeks is commonly long enough to biing the
case to a fatal termination, and it is rare for these
patients to live for three or lour months after the sight
has become aflfected."

Treatjient of Favus avithout EriLAXiON. — Prof.
Enrico de Renzi has undertaken to treat this affection
without removal of the hairs, by the following method :
First, the nature of the disease having been determined
by the aid of the microscope, the hair is cut closely and
the head rubbed with an ointment consisting of one-
tenth part of phenate of soda. After a very short
course of treatment the parasitic growth is seen to
lose its transparency, become granular, and at last is

THE MEDICAL RECORD.

detected, by aid of a magnifying glass, reduced to frag-
ments around the roots of the hairs. Under the con-
tinuance of this treatment it completely disappears,
never to return except as a result of a new engrafting
of tlie parasite. — Lyon Medical.

Gelsemium in Irritable Bladder. — Dr. W. Scott
Hill, of Augusta, Maine {Am. Jouru. Med. Sciences) re-
lates five cases of irritable bladder wliicli were relieved
by the administration of Tilden's fluid extract of gel-
semium.

Electrotherapy. — J. W. Holland, M.D., Prof. Chem.,
Univ. Louisville (.1???. Practitioner), speaks of a case of
" nervous deafness," due to a sudden but enduring
apathy of the auditory oerve, in a patient aged forty-
one, which was considerably improved by the feeblest
current from a volta-faradic coil, after a sitting of five
minutes' length. The revival of the auditory nerves
gained fresh force from each electrical sitting, and he
presumes that, as five applications have accomplished
so much, by continued excitation the torpor may even-
tually be entirely removed.

Uterine Cloth Tents. — In a reprint from the Atlan-
ta Medical and Surgical Journal, Dr. V. H. Taliaferro,
of Columbus, Georgia, gives some practical observations
upon medication by the use of uterine cloth tents in
diseases of the body and cavity of the uterus, with ac-
companying wood-cuts. They are designed as a safe,
read}', and thorough means of intra-uterine medication,
dilatation in uterine cervical structures, and of prepara-
tion of the uterus for intra-uterine injections. That
they accomplish these objects witli greater safety and
thoroughness than any means heretofore employed he
is fully convinced.

Knee-joint Amputations. — Dr. W. H. Hawkins, of
Rocky Comfort, Arkansas (Proceedings Arh. Med. As-
soc), presents two successful cases of this amputation,
and notes the excellent treatises upon this subject by
Drs. Markoe and J. H. Brinton. In general, he be-
lieves that knee-joint amputations compare favorably
with amputations of the leg at any point above the
knee, and as economy in preserving as much of a dis-
eased or injured member as possible is always desira-
ble, this operation possesses decidedly the advantage in
this particular.

In these two cases the antero-posterior flap, with
retention of the patella, was adopted, though the con-
dyles were shaved off. The shaving off of the condyles
he regards as an unnecessary proceeding, and, in future
operations, he will follow Dr. Stephen Smith's method,
as detailed in the Am. Journ. Med. Sciences, 1870. It
admits of a more thorough drainage, and places the
cicatrix in a position least liable to be pressed by an
artificial limb.

A Plan for Facilitating the Reduction of Stran-
gulated Inguinal Hernia by Taxis. — A correspond-
ent of the British Med. Jour, calls attention to a
method recommended by Baron Sentin to be followed
in this operation. The patient is to be placed on the
back, with the hips well raised, and in case the hernial
tumor is not reducible by the ordinary manipulation,
the surgeon is to pass his index finger up into the
ring, if possible to the outer side of the gut. After
crowding the point of the finger past the column of
the ring, strong and constant pressure is made, until
the fibres of the ligament give way, or the opening
is perceptibly enlarged, when it will be found that the
intestine can be returned easily to the abdomen by the
usual effort. The conditions which contraindicate a
resort to this procedure are : —

1. The fact of the hernia being old and irreducible.

2. The presence of the constriction at the inner
ring — the external ring being too small, and the canal
too long, to admit the finger.

3. The existence of general symptoms of grangrene
of the intestine.

Tanacetic Acid as a Substitute for Santonine. —
This acid is prepai-ed by distillation of ihe heads of
common tansy {tanacetum vulgare). The filtered resi-
due is evaporated to the consistency of honey, treated
with lime and animal charcoal, dried, and then dis-
solved in water acidulated with hydrochloric and
acetic acids. Tiie tanacetic acid is deposited in colored
crystals, which are purified by repeated washings with
distilled water. It has a sharp, bitter taste, and is in-
soluble in water, but soluble in alcohol and ether.
Nearly all its salts are crystallizable. As a vermifuge,
it operates in tlie same doses as santonine. — Med. Press
and Circular.

Hysterical Ischuria. — M. Charcot reported to the
Societe de Biologic (Lyon Mcdicale) a curious case (if
true — Ed.) of this affection occurring in a woman 43
years old, who had suftered for several years with
hemiplegia with contractured limbs, and who had an
almost complete supi>ression of urine supplemented by
constant vomiting. The total quantity of urine col-
lected with great care by aid of a catheter was, from
the 8th to the 14th of July, but 4G grammes; from the
16th to the 22d of July, 33 grammes; and from the
24th to the 30th of the same month, 21 grammes.

The vomited matter, analyzed by M. Grehaut, fur-
nished urea in quantities very nearly proportionate to
the amount which should have been normally dis-
charged by the urinary passages.

Effects of Crude Paraffine on the Skin. — An af-
fection of the hair-follicles is described by Dr. Alex.
Ogston in the Edinburgh Med. Journal (Dec), which is
caused by prolonged exposure of the skin to the action
of the oily matter contained in this substance: the
result being an eruption of nodules and pimples on the
skin so exposed, speedily breaking out on those who
are for the first time engaged in handhng it, lasting for
a few weeks or months, and then generally diminishing
or disappearing. In the few cases in which it becomes
chronic a change of employment is a necessity. The
mark of difference between the acute and chronic forms
is the presence of inflammatory action in the former.
A minute examination of the skin in the former variety
shows bright-red nodules which are hard to the touch,
tender onpressure, vaiying little in size,which is about
equal to that of a grain of barley, are of a rounded
form, and consist eacli of a single hair-fohicle with the
surrounding parts red and inflamed. A hair emerges
from the summit of one of these follicles, the orifice
of which is enlarged to the size of a pinhole in a card.
This dilatation extends to the deeper part of the follicle,
which is filled with a dry and friable mass of epithelial
scales and dirt. In the chronic form the hairs have
been atrophied and destroyed by pressure, and the skin
affected presents the open mouths of these distended
follicles, sometimes large enough to admit the end of a
probe, the skin including those raised patches of erup-
tion being of natural color.

The modus operandi of the crude paraffine in pro-
ducing this eruption seem.s to be that the oily matters
in the shale called "blae oil," is irritating to the skin;
and, coming continually in contact with the epidermis,
soaks into the hair-follicles, where it causes an increased
growth of epithelium, which is not counterbalanced by
increased expulsion of the scales, owing to the fatty

THE MEDICAL RECORD.

matter from the sebaceous glands being dissolved out
and rohioved liy tlic "blae oil," tlius leaviiif,' tlio brittle
mass of fpitholiuin to plug "P tlic follicles. I'arts of
the skin not supplied witli hair-foUiclos are not aflocted.
A suprosKn Cause of Heart Disease. — Dr. Moinet
(Kdinbiirgk Mtd. Jour.) offers the theory that ili-ease
of the heart and aorta are produced in some instances
by the weiglit of the heart wlien the subject is in the
erect posture, producing lle.xion of tlie arch of the aorttn,
rendering its curve more acute, and thus oQcring an
increased resistance to the current of blood; corre-
sponding hy[)ertrophy of the heart being tlie first no-
t:ceable result. This bending of the aorta tends also,
he thinks, to weaken its coats, thus laying (he founda-
tion for aneurism at the commencement of its arch,
where it is so often found. He thinks also that soldiers,
on account of the confinement of their chests by their
acoutrements and uniform, and the active and prolonged
exercise of their upper extremities ■while tliey are so
confined, are particularly liable to disease of the lieart
arising from this cause.

Spirits of Turpentine in Phosphorous Poisoning. —
The Bulletin of Hie Royal Acad, of Med. of Bekjium
(No. 9) contains a long article by M. Rommelaere on
this subject, in the course of which numbers of suc-
cessfully treated cases are detailed, the amount of tur-
pentine taken averaging about a drachm daily.

Cutting Microscopic Sections of Eyks. — Edward
Curtis, M.D., of New York (Tra?is. Am. Ophthal. Sac),
devised an apparatus for cutting microscopic sections,
when needed, of an entire eye. In preparing the tissue
and cutting the sections there are one or two points
which it is necessary to observe iu order to get the
best results. Supposing the object to be a morbid eye,
this must, immediately after enucleation, be put into
Muller's fluid — bichromate of jjotash, 75 grains; sul-
phate of soda, 25 grains ; water, 6 fluid ounces — and
there left for at least three weeks. It is then cut open
with a sharp knife or razor, and the halves soaked in
water to remove the bichromate. Such portion as is
intended for cutting in the section-cutter is then to be
further hardened in alcohol. When ready for cutting,
the piece is transferred to light-colored oil of cloves,
where it is allowed to stay froirf half an hour to several
hours — until thoroughly impregnated with the oil.
The piece is then to be imbedded for cutting. For
this purpose the following menstruum is recommended :
one part of oil of turpentine or benzine to twelve or
sixteen of parafline.

The section-cutters and accessories can be obtained
of the makers, Hawkins and Wale, of the Stevens
Institute of Technology, Hoboken, New Jersey.

General Syphilitic Inflammation of the Eye. — Dr.
Francis Delafield, of New York ( Trans. Am. Ophih. Sac.),
says that the iris and choroid are the portions of the
eye which are most frequently attacked after the intro-
duction of the syphilitic virus in the system. In rare
cases, however, the inflammation becomes general;
iris, choroid, ciliary bod}^, retina, sclera, , and cornea
are involved, and the produclion of new cells is so
great that staphylomatous tumors of large size are
formed. The literature of such cases is scanty. Arlt
describes two cases of anterior staphyloma produced
by syphilitic new growths from the edge of the iris
and ciliary body; but no anatomical examination of
the eyes was made.

Von Hippel gives a full description of a case in
which the iris, choroid, sclera, cornea, and retina were
involved, and a large staphyloma formed.

Two cases of this character have come under the
observation of Dr. Delafield, which are published.

Functional Trouble of the Eye. — Dr. Henry D.

Noycs, of New York (Trans. Am. Ophthal. Sac), gives a
scheme to aid in examining and recording cases of
functional trouble of the eye. This printed form he
has used for .several months past, and finds very useful
to insure regularity and completeness in llie examina-
tion, and for convenience in preserving notes. At the
date of report lie had kept notes of one hundred cases
by this method.

Tliis author, in another article, also exhibited an
ingenious apparatus for testing the perception of color.

The Determination of Astigmatism. — An additional
method for the determination of astigmatism is record-
ed by Dr. George Strawbridge, of Philadelphia (I'rans.
Am. OpJiilial. Soc), which has* these advantages: — 1st.
Simplicity. 2d. Accuracy, which results from the ex-
treme delicacy of the test formed by illuminated bar.
3d. The great saving of time. 4th. This method allows
of examination being made entirely independent of
daylight, and so obviating any inconvenience arising
from defective illumination found in cloudy weather,
etc.

Dentigerous Cysts. — In an essay to which was
awarded the first prize of the Boylston Medical So-
ciety for 1871. by W. P. Bolles, M.D. (Boston Med.
and Surg. Joicrmd). it seems that the sexes are nearly
equally liable. Of 23 cases, 11 were males, and 12
females. The number of upper and lower leeth af-
fected is also equal. The majority of the cases oc-
curred between the ages of 10 and 40; 1 to 10, one
case ; 10 to 20, nine ; 20 to 30, nine ; 30 to 40, three ;
40 to 50, none ; 50 to 70, three. Contrary to the usual
statement, but as might be expected from their posi-
tion in the jaw, the lower third molars are the teeth
most frequently encysted, and second to these come
the upper canines. In the appendix, the writer gives
a synopsis of all the accessible cases (29), with the
sources whence obtained.

CoLLEs' Fracture simultaneous in both Arms. —
A case of this character is published by T. Curtis
Smith, M.D., Middleport, Ohio, in the Cin. Lancet and
Observer. The radius of the right arm was fractured
at three-fourths of an inch above the wrist-joint, that
of the left at one inch above the joint. These fractures
were successfully treated by two pistol-shaped sphnts
applied to each arm, after removing the deformity by
extension. At the date of publication the union was
firm, and no deformity can be observed in either arm.
The patient was a boy, aged 10 years, who, while
climbing, was precipitated from a height of fourteen
feet to the ground ; his weight was received on the
palms of the extended hands.

In this case motion is as complete as before the oc-
currence of the accident. Dr. Smith affirms that if
due care is used, deformity will not often follow the
treatment by use of two pistol-shaped splints (!).

Transfusion of Blood. — Carl Proegler, M.D., of Au-
rora, Illinois, late Surgeon German Army (Chicago •
Med. Journal), records four successful cases of transfu-
sion of blood. The patients were French soldiers, who
were wounded in the streets and before Paris. The
indications for transfusion in these cases were : — 1st.
Where amputation had been delayed for some reason,
with but little chance for the patient, but where the
latter insisted upon an operation. 2d. Re-amputation
or resection on account of pyaemia or extreme hemor- I
rhage, either on account of dangerous after-bleeding, J
general debility, or a hemorrhagic diathesis. 3d. Ex-
treme prostration on account of shock, and where life
seems to be in imminent danger. The amount to be

THE MEDICAL RECORD.

injected varies according to circumstances, but it should
never exceed sixteen ounces. Care should be taken not
to force air into the veins, ns collapse is liable to follow.
Chronic IIvpertropiiy of the Lips. — Dr. R. W.
Taylor, Surg, to N. Y. Dispensary (Afed. World), calls
attention, with ca-e, to a form of hypertrophy of the
lips, in which the inflammation begins in its connective
tissue framework, and whicli produces a permanent
augmentation in its size, and in wliich the skin and
mucous membrane are not involved. He observes
that there are five forms of chronic hypertrophy of the
lips due to change in the deep structures: — Tlie first
due to cell-infiltration into tlio corium and papilla;;
the second, to an increased development of tlae con-
nective-tissue stratum; the third, to a hypertrophy of
the mucous follicles and the submucous connective
tissue ; the fourth, to angiomatous tumors, either ar-
terial or venous ; and the lifih due to lymph-angioma-
tous tumors.

Typhoid Fever with Capillary Bronchitis. — In

this complication, when tliere is typhoid depression,
wandering of the mind and bronchial tightness. Dr. N.
S. Davis, of Chicago, 111. (Med. Examiner), recom-
mends the internal administration of chloroform, ac-
cording to the subjoined formula: — IJ. Chloroform,
3 iij. ; acacife, 3 vj. ; sacchari, 3 vj. ; aquae, § vj. M.
Dose, a tablespoonful every four hours, alternately
with other medicine.

Epulis and Myeloid Tumors of the Jaw. — James
Tyson, M.D., Lecturer on Microscopy in the Univ. of
7 exm.. {Dental Times), explains the microscopic points of
diflference in the characters of these tumors, with a
view to a completeness of our knowledge of their nat-
ural history. Epulis tends to occur other than singly ;
it is, however, a growth of all ages, though there are
those who have claimed that it also belongs to yoiith.
Prof. S. D. Gross, on the other hand, in a recent clin-
ical lecture, said that he had never before met with a
growth of this kind at so early an age as seven years.
It is usually a tumor of slow growth, and differing from
myeloid in this respect; it is often painful; patients
afflicted with it suffering much from toothache. Again,
epulis is often partially osseous, frequently containing
spicula of bone in its centre, detached from the surface
of the bone. It recurs under the same circumstances
with myeloid, that is, when all parts have not been
completely extirpated, though perhaps less frequently
than the former. It is generally lobulated, as myeloid
tumor in the same situation, but its structure is firmer.
It is tougher and more elastic, owing to its fibrous
structure. On section of myeloid tumors, more decided
characteristics are noticed, which may be recognizable
by the naked eye. The cut surfaces are "smooth, uni-
form, compact, shining, succulent, with a yellowish, not
a creamy fluid; " presenting "blotches of dark or livid
crimson, or of a brownish or a brighter blood-color, or
of a pale pink, or all of these tints mingled on the
grayish-white or greenish basis-color." Epulis on sec-
tion is uniform, firm, white and shining, presenting
often in its interior the spicula to which allusion has
been already made. Before operation it is not easy to
decide whether a tumor is epulis or myeloid, and
though appearances on section are more characteristic,
they do not become available for diagnosis. As a mat-
ter of prognosis it is not of paramount importance that
the exact nature of the tumor be known before opera-
tion, supposing it one of these two forms, as neither is
apt to return if thorovgJihj removed. Recurrence of
each occasionally takes place, and it is somewhat more
frequent in the case of myeloid ; the periosteum should
in all instances be scraped after operation. As the only

certain means of relief, Prof Gross recommends " ex-
cision of the piece of bone to which it is attached."

Fever Mixture. — The value of aconite in allaying
fevers is apparently not so completely recognized as it
should be ; and having found the following formulas very
beneficial iu allaying fever, and in controlling it when
not dependent upon a deep-seated cause, Prof. Horatio
C. Wood, Jr., M.D., Philadelphia, editor o^ JVeiu Reine-
dies, publishes the following : Take of Tincture of aconite
root, gtt. xxiv. ; Sweet spirits of nitre, ffij.; Solution
(or mixture) of citrate of potash, f 3 iv. Mix. S. Table-
spoonful every one, two, or three hours. Q''his formula,
containing two drops of the tincture of aconite root to
the dose, should be given cautiously, and every hour
only in urgent ca=es which can be carefully watched.
Many women will scarcely bear it given every two
hours. The following combination is more generally
ap[)licable and safer: Take of Tincture of aconite root,
gtt. xij. ; Sweet spirit of nitre, f | ij. ; Solution (or mix-
ture) of citrate of potash, fsiij. Mix. S. Tablespoonful
every one or two hours.

Where there is much restlessness with the fever the
following formula is recommended : Take of Tincture of
aconite root, gtt. xij. ; Sweet spirit of nitre, Comp. spirit
of nitre, ila. f 3 iss. ; Camphor water, f§iij.; Morphia
sulph., gr. ss. Mix. S. Tablespoonful every one or
two hours.

The Use of Sewing-Machines. — Dr. A. H. Nichols,
in the third annual report of the Mass. Board of Health
(Boston Med. and Surg. Journ.), presents a full exhibit
of the effects on health of the use of sewing-machines
moved by foot power, based on personal investigation
and returns from a large number of correspondents,
from which it) is evident that most women cannot
make continuous use of the common pedal for any con-
siderable time without suflering from general debihty
and various local disturbances. These evils may be
prevented by the substitution of steam or foot power
in large establishments, or by the use of electro-mag-
netic power, or by the use of improved pedals, which
greatly reduce the required movement of the feet and
legs of the operator.

Pitting in Small-Pox. — W. C. Coleman, M. D.
(Drug. Circ. and Chem. Gazette), recommends the fol-
lowing, to prevent pitting in small-pox, as the result
of his own observation: First, prevent suppuration as
far as possible; second, allay irritation; and third, keep
the scabs off. To accomplish the first and second, rup-
ture the pocks thoroughly while in the vesicular stage,
and apply carbolic acid and mucilage of gum acacia,
mixing one part of the former to eight of the latter,
and apply freely with a hair pencil. To keep the scabs
soft, use olive or sweet oil freely. Continue the mucil-
age and acid as long as the irritation lasts, and there
need be no fears of the oil interfering in any way,
provided the mucilage is made quite thin.

Hypodermic Injections of Corrosive Sublimate. —
In a practical paper " On the Treatment of Syphilis by
Hypodermic Injections of Corrosive Sublimate," by
Dr. R. W. Taylor, of New York (Med. Gazette), his views
are given, in concluding, in eighteen aphorisms, which
are thus summed up : While in dispensary and hospital
practice the injections may be frequently given, in pri-
vate practice the smallness of a patient's means may
often be an obstacle in the way of the continuance of
treatment. That, while in some cases the treatment
may be useful by reason of its rapid action, and in
others for the smallness of the dose, the inconveniences
which it produces, the objections of the patients, and
the presenee of lesions which contraindicate its use,
confine its sjjhere of usefulness to very narrow limits.

THE MEDICAL RECORD.

Cakdonatk ok Soda. — A new process for tlio produc-
tion of ciulxmiiU- of soda lias lioen iiivi-iitcd by M.
Swftger. IJy tlie joint aid of highly siipcrliiMtid Htoatii
and red lieat, he decomposes the duiilile ciiloride of
aluiiiituiiii and sodium, previously fused, liiiis lormint;
alumiii ite of soda and liydrochloric acid. The latter is
condensed; the former, treated with earl)onic acid,
yields carbonate of soda and alumina.

Lkucin and Tvrosik. — According to James Tyson,
M.I)., Prof Phys. and Histology in Pcnn. Collepo Den-
tul Surgery {.[m. Joiiin. Mrd. Sciences), these organic
nitrogenous substances found in the solids and fluids
of the economy \n a number of morbid states, have only
a marked significance when present in the urine in
connection wiih .symptLiins pointing to derangement of
the hepatic function. Under these circumstances they
are of grave import, indicating destructive diseases of
tliis organ which have hcrctolore invariably terminated
fatally. They do not necessarily indicate acute yellow
atrophy alone, but may attend any affection of the
liver in which there is permanent disorganization of its
])arenehymatous structure, even if it extend over a
period of sevend months. It does not appear to be
present in the urine in cases of liver disease which are
perhaps years in completing their course, as in certain
instances of cirrhosi-^, and simple fatty degeneration.
When there is deficiency of urea in the urine thus con-
taining leucin and tijrosin, the mode of death usual
under these circumstances (coma or convulsions) can
only be rationally explained on the supposition that
there exists a condition analogous to uia;mic poisoning.
or identical with it.

Prof Tys^n presents in full the chemical and
microscopic.d cliaracters, tests, and drawings of these
substances ; also tlic modes of obtaining leucin and
tyrosin from animal fluids and tissues suspected to con-
tain them.

H.«xroPTYSis IK Consumptive Patiknts. — D. Francis
Condie, !M.D., of Phila. (.4m. Journ. Med. Sciences), says
that it is true that the deposition of tubercular matter
in the lungs may be preceded and accompanied by
luttmoptysis, but by no means so generally as to war-
rant iLs being ranked as among the premonitory, much
less as a diai:noslic symptom of tubercular phthisis.
Of 369 cases of tubercular consumption, very full notes
of which he has kept, hajmoptysis occurred in 87 — that
is, about 24 per cent. In 282 of the cases it neither
l>receded nor was present throughout the attack. The
absence, therefore, of haemoptysis is not to be received
in any case as an indication of the absence of pulmo-
nary tubercles, nor can the occurrence of pulmonary
hemorrhage be received as an indication of a future or
present tuberculosis of the lungs.

In the 87 cases of consumption in which pulmonary
hemorrhage occurred under his observation, the he-
morrhage preceded in 40 the first symptom of the
deposit of tubercular matter some considerable time —
say two, three, five, six, or even twelve months; in
some cases, however, it preceded the indications of tu-
berculosis only a few days ; in other.s, again, it occurred
at the very onset, so far as he -was enabled to judge, of
the tubercular deposit. In 29 cases the hemorrhage
occurred at different periods durin? the progress of the
disease, and in its latter stage in 18 cases in which the
presence of cavities in the lungs was detected upon
auscultation.

Fr,ATULEKT Dyspepsia. — The late Dr. Trousseau, of
Paris (New Sydenham Society's translation), in this
form of dyspepsia, administered alkaline preparations
for a few consecutive days, followed by the administra-

tion of bittern. For five or six days, at the beginning
of (he two principal mealf, and on retiring at night, the
following j)owder is u.sefnl : Magnesia, chalk, bicarbo-
nate of soda, 4 toOgrs. each, mixed immediately before
taken in a fourth of a tumbler of waU'r. This to be
lollowcd by I lie employment of quassia. In the morn-
ing fasting, ami atmi<lilay. at an equal interval between
the two principal meals, the i)atient ought to drink a
cup of the infusion of qua.ssia, prepared by leaving a
teacupful of cold water for 1/i or 20 miimtes in a goblet
made of this wood ; or, which is much better, by macer-
ating two granunes cf quassia .shavings in cold water
from four to six hours. In these cases wine of cinchona
IS akso indicated. It ought to be given either immedi-
ately alter meal-, or immediately after the patient has
taken a small quantity of food, in order to prevent the
pain in the stomach which is aj)t to be excited when
taken fasting.

Urktiihai, PAtns. — Prof. Andrews, ofMercy Hospital,
Chicago, III. (Med. Kxaminer), in cases of gonorrhoea
uses the subjoined solution by way of irrigation : cryst.
carbol.c acid, 5 grs. to the ounce, and chloride of zinc,
2 grs. to the runce of water. He has a reservoir hold-
ing a quart or more, five feet above the patient's penis.
A rubber tube, size No. 6, terminating in a flexible
catheter, is attached, and the catheter inserted into the
urethra, but not into the bladder. A quart of the solu-
tion is placed in the reservoir and allowed to run into
the urethra, where, escaping from the eye of the cathe-
ter, it runs out again between tlie catheter and the
walls of the canal, giving the latter a thorough and
long-continued drenching. The effect, he says, is ex-
cellent.

Tnh: Fattv Kidney. — James Tyson, M.D., Philadelphia
(Plii'a. 2fed. Times), in a clinical Iccturo " On a case of
smooth white kidney," mentions the two forms of
fatty kidney, viz.: the smooth ivhitt kidney , and the large
yellow fatty Icidney ; the former being the more com-
mon sequel of acute Bright's disease, especially of the
scarlatinal type. Generally fatal within three or four
years, it is said by Dickinson and Stewart to be amen-
able to successful treatment. lie has never seen a case
of recovery, although he has seen the strength and
general health of a patient temporarily restored while
the urine still gave evidence of the existence of the
disease ; and that the duration may exceed the usual
period is evidenced in the case presented — lasting appa-
rently thirteen years.

Cases of the large yellow fathj kidney are invariably
fatal, and generally within a year after its detection.
This form of fatty kidney. Dr. Dickinson believes, is
more frequently a sequel of the acute nephritis follow-
ing exposure to cold than of the scarlatinal nephritis.
Dr. Tyson can suggest no reason why it should not suc-
ceed scarlatinal nephritis; though he has never known
it to do so. He also believes it may originate primarily,
especially in the intemperate. A case came under his
observation which, he thinks, originated in this way —
in the driver of a beer wagon. The drivers of these
wagons perhaps consume more spirituous liquors than
any set of laborers, because they are expected to invite
the purchaser of every cask delivered to drink with them
— and whiskey is generally taken.

Incomp.^tibles with the Perchloride of Iron. M.
Bouilhon {Xew Remedies' translation from L' Union
Pharm.) gives the subjoined list of incompatibles :
Salts of silver; protosalts of mercury; alkalies, their
carbonates and bicarbonates; the arsenites and arseni-
ates; borate of soda; tannin and vegetable astringents;
gums; vegetable extracts, and vegetable infusions; albu-
men ; casein.

THE MEDICAL RECORD.

The Medical Recoiid:

.1 SEMr-3WXTIILV JOURNAL OF MEDICINE
AND SURGERY.

GEORGE F. SHRADY A.M., M.D., Editor.

Publis/ied on the lat and loth of each Month hi/
WMf. WOOD «& CO., 27 Great Jones Street, 3V. Y.

N^ew York, INIarcli 15, 1872.

THE PROPOSED

DEPARTMENT OF SAFETY

IN THE

CHARTER OF COMMITTEE OF SEVENTY

AND THE

HEALTH DEPARTIVIENT.

The present Health Department of the City of New
York is not one in which either the physician or citi-
zen can take any special piide. The charter which
brought it into existence was framed more for the sake
of extending tlie patronage and perpetuating the power
of the Tammany Ring than for any design of serving
the legitimate interests of the public. Although,
a? a department, it may, by comparison with others, be
considered a very useful one, it has by no means escap-
ed the contamination which its origin and associations
forced upon it. ISTo one was surprised to find that it
was badly constructed, and none are disappointed^ in
learning that it has been badly managed. It is certain-
ly some comfort to know that as the community could
not expect much from it, that it is not now disappoint-
ed. The medical element of the Board, the most im-
portant of all, was designed to be of the utmost insigni-
ficance, and the facts of experience have shown that
the expectations of the framers of the law have been
fully realized. Practically speaking, we might say that
the medical commissioners have been the merest ciphers
as to any intluence Avhich their opinions or counsels
may have had upon their colleagues. The profession
have yet to hear of anything to the contrary of such a
supposition. No one could expect it to be otherwise,
as the Board was constituted, there being but two
medical commissioners, with the Health Oflicer of the
port, against six laymen. It is conceded by every
disinterested person, that there are many questions

connected with sanitary science upon Avhich medical
men only can give any intelligent opinion. These
questions are not unfrequently of the greatest impor-
tance to the commonwealth, and when they are mis-
understood by layman who have, by the mere force of
votes, the power to cancel a strictly scientific opinion,
the consequences are t;ometimes disastrous. Medical
opinions upon matters connected with the public
health are not generally calculated to further the in-
ti'rests of unprincipled contractors, and such others as
by their vocations are abettors of dangerous nuisances.
Such being the case, ii is easy for the layini n in the
majority to be convinced to a contrary opinion, more
especially if the Board is working for political capital.
We contend, in the interests of the people, that in order
that all truly scientific questions connected with public
health should be properly considered and practically
answered, that the medical members should have the
controlling power. They should, in other words, be in
the majority. The medical profession have a right to
insist upon such a provision, and the public, if they
properly understood its importance, would demand it
of their law-givers.

It was the lack of a medical majority in the Com-
mission that has in a great measure rendered it so bar-
ren of practical results as compared with the Metropoli-
tan Health Board, of which the city had no little
reason of being proud. In fact, the only redeeming
feature of the present Commission, and the only meas-
ure that perhaps enabled it to cover up the ignorance
of the framers of the law, was the retention in ofiice of
such of the executive officers as had distinguished
themselves under the old regime. It is but due to
these latter gentlemen to say that they have accom-
plished by hard work every good and acceptable
service for which the membei s of the Commission
claim the credit. While we have reason to congratulate
ourselves that the affairs of the Board are not on this
account as bad as they might have been, we have no
right to expect that such a rule will be so luckily fol-
lowed out in future. On principle, it is just as liable to
be violated as not; in fact — in accordance with the ac-
cepted political principles of the day — more so. The
only way to prevent the possibility of the appointment
of incompetent men to do the executive work of the
Board is to have the medical commissioners in the
majority. Then we shall always have a guarantee for
the appointment of men to do the executive work who
have *he requisite professional capability, and not trust,
as we have done, to the mere luck of a forced expedi-
ency.

The proposed charter is framed upon the principle
of minority representation, a feature which, under the
present circumstances of the city government, is com-
mendable in many ways, and impracticable in others.
By it the legislative power of the corporation is vested
in the Board of Aldermen, who are to be elected in
accordance with the following plan, which governs

THE MEDICAL RECORD.

all elections within the naming of the said charter : —
" Each qualified voter in each Senate District may
give one written or printed ballot witli the indorsement
" Aldermen," which shall contain a list of not more
than nine names. The voter may repeat on such list
the same name nine times, or may make euch list to
consist of nine diflcrent names, or may repeat any one
or more name or names on said list as often as he may
see fit." The principle, if properly carried out, will
effectually check the abuses of power and influence
of which the former political rulers of our city have
been guilty, but in other respects it is a change in the
forms of appointment which in many cases may not be
the most conducive to public welfare. It is in politics
as in everything else, when changes are made there is
too much liability to travel from one extreme to the
other. This spirit of radicalism in tlie cause of non-
partisanship is, in fact, manifest in many portions of the
charter, and not the least so in that referring to sani-
tary regulations.

The charter now in force provides for a number of
useless departments which are drawing from the city
treasury witliout an equivalent return in the shape of
duties performed. As prominent examples of these
we have the Bureau of Street Cleaning and the Permit
Bureau. Tiie chief officer of each of these draws a
salary of four thou.«and dollars for services which are
merely nominal, and for which a salary of five hundred
would be an unnecessary extravagance. This fact has
tended not a little towards making the changes in the
proposed law so absolutely reformatory and so uncom-
promisingly radical. Again, the action of the present
Health Commission, as manifested in the political trick-
ery which culminated in raising their salarie?, already
amply renumcrative, has tended to the same result.
The Tammany party, with a show of reform charac-
teristic of all their endeavors to swindle the public,
caused to be passed by the last legislature what is
known as the " Two per cent. Tax-bill." This pro-
vided that not more than two per cent, of the taxes
should be levied upon the assessed valuation of prop-
erty, out of which amount the whole city government
was to be carried on. A Board of Apportionment was
created by this bill to divide the money among the
several departments and to fix the salaries for 1871.
It is true that the appropriation required by the de-
partment was very much curtailed ; but what was
gained for the apparent benefit of the public in one
direction was, in the direct interests of the Health
Commissioners, lost in another. It was ordered that all
salaries of five thousand per annum and over should be
reduced twenty per cent. The Commissioners, how-
ever, with that disinterestedness of the public welfare
which has characterized their political actions during
the past year, succeeded in having their respective
salaries raised to the modest sum of ten thousand a
year. As this was done before the Board of Appor-
tionment commenced their labors, the said salaries

could safely be left to the necessities of the required
reduction. The result was that, instead of five thou-
tiand, which they each received before their respec-
tive salaries became increased, they actually received,
after the reduction, eight thousand ! It is easy to see
that the pretended retrenchment was a real benefit
to the members of the Commission, while at the
same time the general funds of the Board were
proportionately reduced in such a way a<5 to cripple its
legitimate functions. Since the indignation of the public
h.TS become so justly arous.'d at the extravagance of the
different departments, the salaries of the Commissioners
j have, with a great show of a sacrifice for the public good,
been reduced, since January first. of the present year,
to their legitimate standard.

In view of these fact.'*, it is not to be wondered at
that the Reform Committee have become prejudiced
against the pre.«!ent Board, and have sought for many
changes in its plan of organization. Taking the one
extreme as a starting-point, they have, perhaps natur-
ally, but not, in our opinion, wi.sely, aimed at the other
extreme. There is no doubt in the minds of every
unprejudiced person that the present Commi.ssioners
have by their actions, as a purely political Board, for-
feited the confidence and the respect of the commu-
nity, and that they one and all deserve dismissal;
but that, on their' account, the whole plan of adminis-
tration of the Board, as such, should be so thoroughly
remodelled, is a question of no small moment to practi-
cal sanitarians.

Among the changes proposed by the Committee of
Seventj' is the creation of " The Department of Public
Safety." In order to give an idea of the provisions, we
quote the following : —

"Art. riL, Sec. 43.— The Department of Public
Safety shall be under the charge of seven persons, who
shall be a board to be called " The Board of Public
Safety ; "' said Board shall consist of the Mayor, and
of si.x Commissioners, to be called "'Commissioners of
Public Safety," which Commi.ssioners shall be elected
by the Board of Aldermen in the manner hereinafter
provided.

''/Sec. 44. — Between the 1st and loth days of May,
in the year 1872, six persons shall be elected by the
Board of Aldermen as such Commissioners ; at such
election each alderman shall give not more than six
open ballots, upon each of which shall be printed or
written the name of one candidate for the office of such
Commissioner, and each of which shall be signed by
the alderman voting, and shall be recorded by the
Clerk of tlie Board. Each alderman may give the
whole of his ballots for one and the same candidate, or
may distribute them between six diflerent candidates,
or in a less number, in such proportion as he may see
fit. The six persons having the largest number of
votes shall be deemed elected. In the event of a
failure to elect six Commissioners, by reason of less
than six persons having been voted for, or by reason

THE MEDICAL RECORD.

of two or more of the persons voted for having re-
ceived an equal number of votes, under sucii circum-
stances that there shall be no full number of six
persons having received a higher number of votes
than any others, a new election for six Commissioners
shall forthwith be held in tlu; same manner."

Section 45 provides that the Commissioners elect
shall divide themselves by lot into two classes of three
each, one of which classes shall hold office for three
years I'rom the 15th day of May, 1872, and the other
for six years from same date.

This department also provides lor a division into live
bureaux respectively as follow : I. " Bureau of Police,"
the chief officer of which shall be ■' the Superintendent
of Police; " 11. a Fire Bureau, the chief officer of which
shall be called" the Chief Engineer of the Fire Bureau;"
III. a Bureau of Health, the chief officer of which shall
be called the Sanitary Superintendent ; " IV. a Bureau
of Buildings, the chief officer of which shall be called
''the Superintendent of Buildings; " and V. a Bureau
of Statistics, the chief officer of which shall be called the
Register of Records."

This Department of Public Safety it is intended shall
represent the Police. Health, and Fire departments, and
in addition the Department of Public Buildings. How
all the supervisory" duties of these can be compressed
into the labors of a commission of seven persons is an
enigma in the first place, and, in our opinion, will prove
to be an impossibility in the second place. The concep-
tion of such an idea can be explained only on the ground
of a determination to court a dangerous and stupid
extreme. We fail to see how this board can, consist-
ently with even a common-sense idea of their duties,
attempt to perform one-half of what even as an advi-
sory committee the community require of them. The
real work must be done by tiie different heads of
bureaux, and the Commission must necessarily be more
ornamental than useful. It is impossible to conceive
how the Commission can affect the workings of the re-
spective bureaux except as the passive instruments of
the necessities of each, or as active hindrances to the
efficiency of the respective executive departments. If
the Commission is really to be good for anything it
should be competent to exercise an intelligent control-
ling power over all — which, under the circumstances,
seems to be simply impossible.

Each of the bureaux, if they require anything, should
have a commission practically competent to advise and
direct the executive officers. This should be particu-
larly the case with the Health Department. There
are many questions connected with the health of the
community which, as before intimated, cannot be de-
cided upon by any save a committee of strictly medical
men. We have always held to the opinion that a model
health law should provide for a distinct health com-
mission, composed, if not entirely, at least of a majority
of thorough [jr educated physicians who should be com-
petent to direct the officers under them. Practical sani-

tarians need no argument to prove the utility of such
a measure, and the real interests of the citizens de-
mand it.

The appointment of such health commissioners
shoidd be very carefully made by thoroughly compe-
tent and responsible parties. Far from the acknowl-
edgment of any such necessity, the Board of Alder-
men are left with the whole discretionary power of
electing any applicant they may .sec fit. There is no
provision whatever for the election of any medical man
to that office, and yet this Commission is supposed to
be able to advise intelligently concerning matters per-
taining to the health of the community ! Even if
such a provision were made, the medical gentlemen
could not possibly claim a fair representation in such a
board, and would be sure to be in the minority when
any vote was to be taken upon any measure i-eferring to
proper sanitary regulations. In any event the influ-
ence of the profession would be, in matters over which
it is pre-eminently entitled to opinions, a mere cipher.

Again, supposing the profession were to bo fairly
represented, what guarantee is there that the aldermen
could or would make an acceptable choice. Would it
not be more probable that, under the circumstances, the
only candidates who would stand any chance for elec-
tion would be those who could command the most poli-
tical influence with the Board as a whole ? This latter
recommendation is not such as the respectable portion
of the medical profession as a body can allow them-
selves to court.

We are constrained to confess, at the risk of being
considered out of the fashion, that we are in favor of
the constitution of a Health Commission by itself; that
this Commission should consist of a majority of well-
qualified medical men, and that the members should be
appointed by some more responsible parties than a
board of aldermen whose official functions as electors
are so blindl}'- hemmed in by the principle of minority
representation. A responsibility of appointing the
members of such a commission in such away, shared as
it is among so many, amounts to nothing, even should
the complication of the machinery allow them to come
to any choice at all. While we may approve of the
experiment of minority representation, we have no
liesitation in objecting to the principle as applicable to
the appointment of the members of the Committee of
Safety, As a committee we object to it as wholly in-
capable of performing the duties to be assigned to it,
especially those as referring to health matteis. There
is, in our opinion, very little improvement to be made
on the old Metropolitan Health Bill, not only as re-
gards its organization, but as regards the responsible
appointing power. During its operation it gave very
general satisfaction, and the repeal of the old law was
not warranted by any improvements which the present
law effects or the proposed law contemplates.

THE MEDICAL RECORD.

TIIK MKmCAl, WOItl.l).

TiiK ifnltcal Worhl, for February, comes to us with-
out an Editor. We arc simply told that " Dr. Reuben
A. Vanco, wliose name lately appeared as editor, is no
loiipiT connected witli the Malical Worlil."' This an-
nouncement is brief and explicit, and the publishers
evidently scorn any explanation. It is fair to presume
that this isanotlier one of tliose serious misunderstand-
ings between the publishers and the editor, in which
the former being the owners of the periodical, the latter
is pretty sure to be worsted. But tliis aciion may admit
of all sorts of explanations, and except from an unpar-
donable discourtesy to a professional gentleman, who
has shown himself qualified to conduct such a journal,
no one would be particularly interested in the matter.
The affair, however, wears a serious aspect when the
publishers assume the editorial control of a journal, and
i npose their opinions upon the subscribers. They
p:o:nis? almost everything in the line of medical jour-
nalism, and state that in return for their labors they
want a circulation often thousand copies per month (!).
In order to prove to their subscribers that they are
capable of doing what they promise, and that they fully
appreciate how the English language should be used,
we will quote the following paragraph of their an-
nouncement referring to the prospective ten thousand
subscribers: "Out of nearly seventy-five thousand
physicians in the United States, of all classes, there is
no medic d journal having anything like the above cir-
culation." We sliould hope not.

The profes-ion owe it to their self-respect to frown
down any such presumption on the part of publishers
of medical journals, and should cease t:> patronize any
undertaking actuated by such a spirit. We predict for
th.: journal a deserved failure.

Ucports Df Societies.

TOE rn.VRMACY BII.I.

Up to the time of our going to press, the fate of the
Pharmacy bill is still undecided. It is now before the
Health Committee of the Assembly, and in the hands
of its chairman Dr. Robert Louguray, and the other
medical members of that committee, it is to be hoped
it will receive the merit of a favorable report. Senator
Weismans has done his part in the matter, and it is not
fair to suppose that Assemblyman Loughrax and his
medical confreres will be found wanting when the time
comes to hear from them. The professions of medicine
and pharmacy, in this city, are alike interested
in the passage of the bill, and they naturally look
to their respective representatives in the legislature to
have their unquestioned rights guarded against the un-
principled machinations of the defenders of the present
obnoxious and oppres-sive law. There can be no argu-
ments against its passage save such as are so strenuous-
ly urged by the interested office-holders under the pre-
sent law.

MKDK'AI. LIIUIAHY AND JOURNAL
ASSOC lATlUN OF NEW YORK.

Slated Reunion. February 9, 1872.

Dii. W. N. Blake.man, Vice-President, in the Chair.

TENOTOMY IS MVOPIA.

Dr. R. II. Deubv read a paper upon Progressive Mi/o-
pia and i's Operalire Cure, advocating the doctrine
that the large majority of cases of progressive near-
sightedness are attended \>y, and to a great extent de-
pendent upon, insufficiency of the internal recti and
lience to bo relieved by division of one or both of the
exlerni. The rules, so carefully elaborated by Von
Graefe, both for determining the propriety of this ope-
ration, and for securing by it exactly the degree of
effect intended, were given in detail. Several cases
were cited from the practice of Von Graefe and others,
where the myopia had not only been arrested in its
progress b}' the operation, but had even considerably
diminished after it; and the paper concluded with re-
ports of selected cases from the writer's own records.

Di?. KxAPP, wliile fully endorsing the rules laid down,
as having rescued the operation from the domain of
empiricisiii to that of strictly scientific surgery, was yet
inclined to think the range of its applicability more
hmited than Von Graefe and his adherents contended.
In his own experience the cases of myopia attended by
a degree of insuQiciency of the internal recti, sufficient
to warrant the operation, were comparatively rare.
Indeed, while admitting that insufficiency of these mus-
cles was more frequent in myopic than in emmetropic and
hyperopic persons, he nmst yet state, in opposition to
Dr. Derby's assertion, that only a small percentage of
the cases of near-sightedness was complicated with such
insufficiency. Few cases of myopia were progressive
after the age of twenty-four, or thereabouts ; and in
these severe ones tenotomy was apt to fail of the de-
sired effect. This, he thought, was due to the aetiology
of the afi'ection. Pressure of the recti upon the globe
had probably less to do with its causation tlian persist-
ent strain of the accommodaiion ; the steady contrac-
tion of the ciliary muscle interfering with the venous
outflow at the anterior part of the eye (through the
canal of Schlemm), and hence producing passive hyper-
aemia of the choroid with transudation, and softening
in the coats of the posterior part of the globe, which
then yield more readily to the intraocular pressure
and become extended.

Dr. Pooley agreed with Dr. Knapp, and would cut
the external recti only in cases accompanied by evident
muscular asthenopia.

Dr. Derby insisted upon the insufficiency of the in-
terni only in cases of prof/ressire myopia, stating that
it was found in nine-tenths of these cases. It pro-
duced its eflects, doubtless, not to any great extent
directly, by causing an increase of pressure upon the
globe ; but indirectly, by inducing that very strain of
the accommodation to which Dr. Knapp had referred.
This was in virtue of the intimate a-sociaiion between
the contraction of the ciliary muscle and the effort at
convergence of the optic axes. If this efi"ort were in-
creased by weakness of the internal recti, the muscle
of accommodation must be constantly stimulated to
excessive action.

Dr. Pomeroy thought the difficulty of converging

THE MEDICAL RECORD.

the optic axes was sometimes an advantage to the
myope. It would lead him, when his eyes were fatigued,
to abandon the effort to fust^ the two image.-, and use
one eye only, relaxing the strain upon tiie acconnnoda-
tion, and placing tlie object somewhat further off.

Dr. Kx.vrp called attention to the liict that frequently
the worst cases of progressive myopia were tho?e in
which this very thing was constant — where the jiatient
never used but one eye for near work, and where, there-
fore, there could be no pressure of the recti upon the
globe, or strain of accommodation from tlie effort at
convergence. The relation between the effort to con-
verge the axes and that to accommod.ite was not a
fixed and necessary one — so much convergent effort
necessitating so much accommodative — but was purely
a matter of education.

NASAL DOUCniiS.

Dr. Burrall presented two nozzles, to be attached
to a Davidson's syringe, for showering the nasal cavity.
The first was about the size of a No. 8 catheter, some
four or five inches long, and pierced on one of its quad-
rants Avith three longitudinal rows of holes. The in-
tention was that wdien the instrument, introduced into
the nostril, was laid upon the floor of the nose, the outer
row should throw its streams into the inferior meatus;
the middle row, into the middle meatus ; and the upper
row, directly upwards toward the roof of the cavity. The
second nozzle was the ordinary bent one for washing
out the posterior nares, except that the rose at its end
was made to throw three sets of streams forwards and
upwards on the plan above given.

Adjourned.

NEW YORK ACADEMY OF MEDICINE.

IStuted Meeiiuffj Fehruary ], 1872.
Dr. E. R. Peaslee, President, in the Chair.

REPORT ON YACCINATION.

Dr. Gouverxeur M. Smith was added to the Commit-
tee on "Vaccination in place of Dr. H. D. Bulkley,
deceased. The Committee is composed of the follow-
ing gentlemen : Drs. Elisha Harris (Chairman), Wm.
C. Roberts, Alfred C. Post, Stephen Smith, Jonas P.
Loines, Frank P. Foster, Edward H. Janes, and G-ou-
verneur M. Smith.

Dr. Roberts read the report, of which the following
is an abstract: The daily observations and experi-
ence of physicians have, for seventy years, uniformly
proved that in their personal exposure to the sick of
small-pox, and by the severest testing of the attend-
ants of the sick in hospit-jl, sick-room, and ambulance,
thorough vaccination continues to give full protection
against the contagion, for they are freely exposed
to its presence, and even to its touch, without harm.
Thorough vaccination is thorough protection against
small-pox, and is as effective now as in the time
of Jenner. It is generally admitted, and clearly proved,
that thorough vaccination protects against small-pox
without danger to life or diffusing any infection.
Scarred and disfigured faces are rarely met with at
the present day, except in persons who, having neg-
lected to be vaccinated, have taken small-pox in the
natural way. In proof of this protective influence
of vaccination, and the liability to infection without
it, we may mention that in a severe epidemic in Nor-
wich, England, of 306 persons in several families,
there were among 91 vaccinated persons, two cases
of mild varioloid, and no deaths; and of 215 unvac- j

cinated persons, 200 took the disease, and 46 of them
died.

Revaccination is reconmiended, not only as a meas-
ui'c of renewed secuiity against sinall-pox, but as a test
of the completeness of the first vaccination. It is ne-
cessary to test the completeness of protection and to
exhaust the receptivity of small- pox, and of vaccina-
tion itself. He who is insu.sceptible to one or more
revaccinations Avith fresh viius may generally deem
himself as secure as vaccination, or even an attack of
small-pox itself, can make him.

Small-pox, it is true, occurs occasionally in persons who
have been once vaccinated ; but its occurrence is very
rare in those recently vaccinated, or revaccinated once
or ofcener, or in those in whom the first vaccination was
thoroughly good, as judged by the Jennerian rules for
vaccinaiion. In these instances the disease manifests it-
self oficnest in mitigated form, known as varioloid, and
the protection afforded by vaccination is found to be
equal to that which is conferred by a previous attack
of small-pox. It is believed that a revaccination will
destroy any susceptibility to small-pox infection which
may remain from incompleteness or imperfection of the
primary vaccination. In the army of Bavaria revac-
cination has been compulsory since 1843, and from that
date until 1857 — a period of 14 years — not even a single
case of unmodified small-pox occurred, nor a single
death from the disease. The vaccine virus now in use
in New York City is justly regarded by the most ex-
perienced physicians a? trustworthy and effective, and
afiords all the necessary protection. Yaccine virus is
not a carrier of other diseases. To a neglect of reason-
able precautions, and to carelessness in the performance
of the first vaccination, are due the unmerited discredit
into which this greatest boon of a merciful Creator has
occasionally fallen, and the fatal objection of certain
classes to its employment. Y'ith due precautions, no
other disease than that of vaccinia will be communi-
cated. The distinguished English vaccinators, Dr.
Marson, in 40,000 vaecinations ; Dr. Leese, in as many
more; Sir Wm. Jenner, in 13,000 sick children and
adults in London, and Dr. West, of the Children's Hos-
pital, in 26,000 children — all concur in saying that
they have never seen any other diseases communicated
with the vaccine, and that they disbelieve the popular
reports that diseases are so communicated, nor is the
child li'om whom the lymph is taken found to be suf-
feiing from the disease it is said to have imparted.
Fresh lymph is always to be preferred when it can be
obtained; but crusts may be used if such lymph is not
t J be had, and there is immediate necessity for vaccina-
tion. W^hen practicable, it is desirable to vaccinate
from arm to arm, with virus taken on quill-slips di-
rectly from a healthy individual to the arm of another.

Yaccinaiion, by preventing small-pox, indirectly di-
minishes scrofulous diseases ; and the death rate of
most constitutional diseases, to say nothing of small-
pox itself, has materially decreased as the practice of
vaccination has increased ; and not only has mortality
been diminished, but life has been lengthened and pop-
ulation augmented. The exact reverse is true of the
former practice of inoculation of small-pox.

There is no age at which a person should or should
not be vaccinated, when a necessity exists for im-
mediate protection against small-pox; but it is best
done in early childhood, for then the irritation is less,
and the child unable to relieve itself by scratching
the part, which, with the irritation of the clothes, often
interrupts the progress of the vesicle, causes it to dis-
charge prematurely, and become inflamed ; whereby a
vaccination, which might have run its course naturally,
becomes altered, and an inflamed angry sore is pro-

THE MEDICAL RECORD.

duced, leaving a deformed and ill-looking srar and a
diminislied protection. Matter, too. taken from such
a sore is worse than valueless. The nge of three
months is, on the whole, to be preferred. The most
distingnished English authorities in vaccination, Simon,
Marson, Soaton, and others, recommend, as preferable,
and as ensuring greater idtimate protection, four or five
separate good vesicles ; and of these, in taking virus for
the purpose of vaccinating others, one at least should
remain untouched.

The utmost care should be taken, in the performance
and managem«'nt ofa (irst vaccination, to make it as near-
ly perfect, regular, and exhaustive as pos-ible ; for upon
this depends very much the after-susceptibility to small-
pox, and it is very doubtful whether any amount of
subsequent revaccination will fully compensate for the
deficiency of the first.

The period for revaccination may be delertnincd by
circumstances ; it never can be done too early or too
promptly in persons exposed to small-pox, and it should
be performed in every person soon after the age of
puberty, however frequently it may be repeated at
earlier or later periods of life. It may succeed at one
time when it would not at another; indeed, it appears
to be true that revaccination, as well as primary vaccina-
tion, actually takes more readily in some years than in
others. "One thorouiihly good vaccination to start
with," says Seaton, " and one careful revaccination
after puberty, are all that is ueces-ary for protection as
complete as any know-n proceeding can give against
small-pox." After the twenty-fifth year of age the lia-
biUty to small-pox in the well vaccinated is very small.
Of the nearly 50,0(10 rcvaccinations in the Prussian
army in the year 1833. only about one-third were per-
fectly successful ; resembling, that is, the results of a
primary vaccination so closely as scarcely to be distin-
guished from it ; the remaining two-thirds being more
or less modified, or failing entirely. In other trials on
a large scale the success has not been as great. It should
be remembered that secondary small-pox occurs on an
average in about one per cent, of cases ; and that while
we urge revaccination both as a test of remaining re-
ceptivity to it and of further exhaustion of Avhat may
remain, it is well known that a single well performed
vaccination, perfect in all respects, with few exceptions,
suffices to secure for life an individual subjected to it.
The small-pox has lost none of its malignity and viru-
lence, and while unvaccinated persons are allowed to
accumulate, it is vain to hope for any exemption from
epidemics of greater or less extent. In times of epide-
mic prevalence of small-pox, all should encourage vac-
cination. Vaccination and revaccination are positive
duties. In order to give complete and assured protec-
tion against small-pox, every person not recently and
thoroughly vaccinated should be at once revaccinated,
and in subsequent life should repeat this duty as often
as every five or six years, until in adult life the repeated
revaccination cease to have effect.

Dr. Theodore "Walser then read an extended paper
on "Quarantine Regulations," which we have already
presented to our readers.

The Academy adjourned.

Stated Meeting, Februarij 15, 1872.
Dr. E. R Peaslee, President, in the Chair.

DISCUSSIOX OK QUARANTINE REGULATIONS.

The Secretary read a letter announcing the death of
CfiARLES A. Lee, M.D., of Peekskill, N. Y., a Fellow of
the Academy.

Drs. W. C, Roberts and Elisha Harris spoke of his

extensive acquirements and attainments in his profes-
sion, and how much he was esteemed as a teacher and
editor of medical works. The intere.'-t he evinced in
the management and treatment of the insane was par-
ticularly dwelt upon.

TUE QUESTION OF QUARANTINE.

The President appointed Drs. Theo. Walser, Elisha
Harris, J. C. Peters Austin Flint, and John O. Stone
as members of the Quarantine Committee, according to
the subjoined Resolution passed at the previous meet-
ing:—

Jiesolved, that a Committee of five members be ap-
pointed \)y the Academy, to examine and report such
facts relating to Quarantine as will furnish the Acad-
emy a correct and useful record in regard to Sanitary
duties, in controlling exotic diseases.

Dr. a. N. Rell, of Brooklyn, after some preliminary
remarks, then spoke as follows : Assent to the appli-
cation of quarantine necessarily involves the acceptance
of certain propositions, which are, as yet, far from being
beyond question. One of these questions, ihe po7-tabil-
ity of yellow-fever poison, has been incidentally con-
sidered to some extent recently before the Academy ;
and it is, perhaps, fortunate that the present subject
has necessity for its appHcation. Quarantine regula-
tions, in all their bearings, depend upon our apprecia-
tion of epideniic diseases, and without accurate knowl-
edge of the natural history of epidemic diseases —
including of course those usually denominated con-
tagious — it is altogether impossible to have an intelli-
gent comprehension of the utility of quarantine. And
this view of the subject, even at the outset, is not only
discouraging but humiliating.

Who among us can confess to understand the natu-
ral history of any one of the epidemic diseases, which
we would be likely to class as quaranlinable ?

"What do we really know of the qualities and attri-
butes of epidemic diseases ? For it is only that
which we know, that we should attempt to control.
Of all the uncertainties in the history of the medical
art, knowledge of epidemics takes the lead. That
which has been learned and confidently asserted in one
generation, or even in one year, is not infrequently
contradicted in the next. But let us not desjiair, some-
thing has been learned; enough, it is hoped, to stimu-
late action and research in a fruitful field, and, at
least, to try to apply the little Ave have learned.

All epidemics possess some attributes in common,
such as alternating periods of development, decline, and
disappearance. They are about equally liable to occur
sporadically, or to prevail within the narrow limits of
places to which they are most common — without ten-
dency to spread beyond. And 3'et they all have thf ir
cycles, exhibit marked dispositions to multiply and dif-
fuse themselves broadcast, and to become pestilential,
and then again to return to their usual haunts, as if
exhausted, or having died out, for the want of food,
and a subclass seems to possess the qualit}' of being
antidotal to themselves. These characteristics are
wonderfully analogous to our more accurate knowledge
of certain living organisms, both in the animal and
vegetable Avorld.

The speaker noted some points in natural history,
and remarked that we might follow out the self-antido-
tal effects of the whole category of the ferments, and
appreciate their analogy to certain contagions.

But besides all this, each epidemic disease should be
studied by itself; and all its attributes in relation to
the circumstances of its existence, in common with, or
in exception to, all the rest and to all other natural
phenomena, not confined to one place, region, or coun-

THE MEDICAL RECORD.

try only, but through all its various vicissitudes,
marking well its distinctive signs and properties, and
the antecedent meteorological and local conditions.

Already has this kind of investigation progressed far
enough for the acceptance of certain peculiarities, which,
by common consent, exclude most epidemic diseases
from quarantine restrictions. Of such are, measles,
whooping-cough, scarlet fever, diphtheria, erysipelas,
cerebro-spinal meningitis, and relapsing fever; and to
these may be added typhoid fever, and the common
forms of intermittent and remittent fevers. The reason
for this exemption consists in the knowledge of their
known persistence ordinarily, and permanent existence
in most communiti(!S which they infest ; or their con-
tinuance, at least, for months and years at a time, and
for the most part — particularly the exanthems — their
marked independence of ordinary local conditions, in
respect to their general dissemination. These condi-
tions place such alFections outside of the capabilities of
quarantine, consistent with reasonable burdens, and
narrow it down to a final class, now commonly ac-
cepted as quarantinable, because they, too, have certain
chai'acteristics in common, and from the knowledge we
possess of their natural history are, at least, partially
restrainable by quarantine.

These are: small-pox, typhus fever, yellow-fever, and
cholera. The common characteristic of them all is por-
tability. Of their characteristics individually, scarcely
could four diseases be selected more unlike each other.
With respect to small-pox, nothing need here be said of
its natural history. It will suffice to state, that the ca-
pabilities of quarantine to restrict it are so slight as
compared with the universally accepted and only
means, that quarantine for it should be wholly and ex-
clusively restricted to the care of the sick, and the dis-
infection of clothing, baggage, and merchandise, includ-
ing, of course, the vessel ; and the vaccination of all
persons recently exposed, or who have not recently had
the disease. Immediately after vaccination and disin-
fection of clothing, all such j^ersons should be allowed
their freedom.

It should be taken for granted that every communi-
ty protects itself against small-pox by vaccination;
that this is an accepted recourse of internal hygiene
which annuls the exceedingly sUght danger from the
practice herein advocated.

Typhus Fever. — In regard to this disease, if I remem-
ber corrpctly, I must take issue with Dr. Walser. Less
portable, I have no doubt, than yellow-fever, but at.
least sufficiently so; in my judgment, to contaminate
clothing and certain merchandise and, above all, vessels.

Aitkin says: "There is ample proof that typhus
fever may be commiunicated by fomites — adhering to
apartments, articles of clothing, and the like ; and pro-
vided fresh air be excluded, it is known that such
articles will retain the poison for a long time. Herein
lies a fallacy which pervades the argument from cases
to prove the generation of the disease de novo. The
poison may be said (like that of small-pox) to be con-
stantly in existence . . . ; that it is undoubtedly
propagated from pre-existing foci, and by continuous
succession. There are also good grounds for believing
that typhus fever may be communicated, and even
carried a great way, hy fomites, or by articles of clothing
strongly impregnated with the specific poison."

Murchison, also, gives a number of striking examples
of the communication of typhus from fomites; and
particularly the recent case of the Egyptian ship " Sche-
ah Gehald," at Liverpool, the crew of which disseminat-
ed the poison of typhus by their clothes and person?,
although, he says, they had not the disease themselves.
Subsequent investigation of this case by Dr. Parks and

others showed that some of the men belonging to the
ship had had the disease, and communicated it by its
more usual means — personal contagion ; but this fact
does not impair the other, that it was also disseminated
by the clothing of the well. Pringle, Lind, Bateman,
Jacquot, and othci'S give numerous examples of the
persistence of typhus poison in rooms, attached to fur-
niture, clothing, etc. ; and Lind, in particular, of typhus-
infected ships, which continued to impart this disease
long after the original sick had been removed. Jacquot
gives similar examples in his account of the Crimean
typhus on board the French ships. A number of the
French transport ships took infected troops from the
Crimea to Constantinople. Among the passengers who
embarked homeward, typhus frequently broke out,
without any reason to suspect that it had spontaneous
origin.

Lini] mentions cases, where persons, not ill them-
selves, have by their clothing imparted the fever to
whole ships' companies; and he also'cites the danger
to washerwomen and nurses from clothes and bedding.

Says Murchison, Woollen substances, in particular,
are the most prone to absorb and retain animal exhala-
tions, and most fitted to transmit typhus poison, and
reprehends the use of street cabs for the conveyance of
typhus patients.

Surely after such well-proven dangers — and more
might be cited — the danger of contaminating certain
articles of commerce, such as woollens, for example, in
a badly typhus-infected ship, would hardly seem
questionable.

Cholera. — By the epidemics of this disease during
the last ten or twelve years, we have learned enough
of its history to be quite certain that it is at least con-
strainable, if not controllable, by quarantine. It would
be useless, in this presence, to rehearse the history of
recent epidemics, and its now accepted mode of dissem-
ination, or to cite the numerous examples of its trans-
p)ortation, not to say its portability — by both vessels
and fomites.

If I am not mistaken, Dr. Walser would confine his
quarantine regulations ibr this disease wholly to per-
sons. The vessel in most cases, and the cargo in all, he
regards as invulnerable. No doubt, this would be good
practice in many cases, but most of us are sufficiently
familiar with its fatal portability by means of personal
clothing and baggage, and its extension from one vessel
to others, and toshores in the vicinity; without conti-
guity, in Jaffa, Alexandria, and several other places in
1865-6. And all of us know the increased danger of
stale cholera discharges within certain limits ; and some
of us, at least, know the extreme liability of these dis-
charges to get adrift on board ship — and to spread and
pernieate, it may be (for we know not how small or
how volatile this cholera poison is), not only every part
of the ship but into the material of merchandise, as well
as personal clothing.

All of this, to say the least, is perfectly consistent
with the nature of cholera poison, to the extent of our
knowledge, and it is to just that extent that I would
apply the quarantine and disinfection of merchandise
and vessels, as well as persons, in efforts to restrain
cholera.

Yellow-Fever. — The natural history of this disease
has recently been so ably presented by Dr. Nott, and
its acceptance as one of the most quarantinable of dis-
eases is so generally acknowledged, that little need be
said of it in this connection. I avail myself, however,
of this opportunity of strengthening my evidence in
regard to the portability of the particular epidemic of
1847-8, which Dr. Nott quoted authority for pronounc-
ing otherwise. On referring to certain records in my

r.8

THE MEDICAL RECORD.

po.=scs'ion for tlic j-oar 1848, I fiml (hat tlie number of
ycllow-ffvor inR-(;tod vessels from tlic l.'Uli of Mnrcli of
that year to iho o:ul of Dt'ccinbcr, a jH-riod of nine and
a lialf month.-!, was 44, — the largest numbi-r, I believe,
on record for tliis port for any one year, with the single
exception of 1850, when there were, from the 1st April
to tlie 1st t)f Angust, 47.

Finally, in regard to quarantinable epidemics, as well
as most others, it may be safely stated, iiro conditions
are generally necessary to their introduction into most
communities: The presence of l\ic special poison; and
the susceptibility of the place as well as persons to
which the j>oison is applied. That, however rigid quar-
antine restrictions, if there be not also rigid internal
cleanliness, quarantine is likely to be inefteclual.

Dr. Wal>er and others tell us that by the fumes of
chlorine, sulphurous acid, iodine, bromine, vaporized
carbolic acid, and such like, applied to the hold of a
ship, or even to the outside surface of such a mass, it
is disinfected. Impossible.

It may be freely conceded, that if the infected mass
could be penetrated with chlorine, bromine, or iodine
the living organic matter therein would be destroyed.
Years of reflection and increased opportunities of test-
ing its efficacy confirm all that I have hitherto advo-
cated in regard to the use of steam as the only available
means with which I am acquainted, for the disinfec-
tion of vessels under the circumstances described. Chlo-
rine and other vupor.s that have been, and can be, added
when deemed necessary, no doubt contribute to the
potency of steam under extraordinary conditions, but,
for the most part, they are unnecessary. For, while it
is perfectly practicable to raise the water at the keel-
tson and the mud in the limbers to a boiling tempera-
ture, there has as yet been no instance within my
knowledge, of the revivication of infection after subjec-
tion to a temperat;ure of 175° for a period of two
hours.

Dr. Bell concluded his remarks by giving a brief
abstract of the Merchants' new quarantine bill now
before the legislature. Its chief improvement on the
laws as they now obtain consists in doing away Avith
most of tlie abuses pointed out by Dr. Walser, such as
the interminable detentions, abuses of lighterage, etc.,
but retains the clause m regard to all foreign vessels
being subject to visitation. This he approved of, not
for the reason given by Dr. Walser for its first enact-
ment in 1856, to make the Health office lucrative, but
because of the greater liability of vessels from foreign
ports to infection, and the necessity for exacting clean-
liness. The proposed law provided that such vessels,
having no disease on board, shall be detained no longer
than requisite for due examination in this respect. It
also makes a distinction between the treatment of ves-
sels and merchandise infected with the different quar-
antinable diseases ; exempting the merchandise of
vessels with small-pox and typhus fever from lighter-
age, and subjecting that of vessels with cholera to
lighterage only under exceedingly rare conditions.
Cape Henry had been substituted for Cape Henlopen,
in the latitude, and May for April, in the scope of
restrictions. The Board of Appeal has been changed
by adding to the Commissioners of Quarantine the pre-
siding officers of the Chamber of Commerce and the
Ship-owners' Association.

Upon the whole, the speaker considered the proposed
law a great improvement, while it was a substantial
contradiction tj allegations that had been made against
the merchants of New York, that they are unwilling to
gubmit to just quarantine restrictions.

Dr. Elisiia Harris, in making the inquiry, How
much danger is there from these exotic diseases ? — said

that having answered that, how is it that we exact so
mueli from the ."^hip if there is so much danger from the
disease's? He tlmuglit tiie danger from yellow-fever
was exaggerated and misstated. Only two per cent,
of the vessels coming from infected j)orts have been
really found subject to suspicion. If two per cent, is
the true amount, this aspect of medical re.-ponsibility
to the public is not really understood and appreciated.
None of the quarantine laws are based on sound rea-
son, much less on medical science. The public should
be protected from a medical point of view. The
speaker was pleased with the spirit manifested by
medical mt^n for advancing tlie public interests, and
the relief of burdens, and advocated more organization
of sanitary autl'orities.

In regard to the reform bill now before the legisla-
ture, the trouble was that the management rested in
the hands of members outside of the medical profession,
with the exception of Dr. Bell. The Board of Appeals
was so made up, that if the jihysician was necessarily
absent, not a medical man would be represented.

The subject of quarantine has assumed a new aspect.
According to Pettenkofcr, quarantine does not pre-
vent cholera from going from place to place. It is the
easiest thing in the world to get up a panic in regard
to quarantine. If the sanitary au thorites of the cities
of New York and Brooklyn were consulted, in refer-
ence to the framing of quarantine laws, and matters
pertaining to them, it would be well; but the whole
management is outside of them He contended that
nine-tenths of all the detentions to ships could be
prevented if all that Avas known could be applied.
This placing the whole external measures of hygiene
outside of medical management has the effect of
exhibiting the profession in an erroneous light.

Dr. Walser remarked that typhus fever was scarcely
known in Continental Europe. He could not see how
typhus and other eruptive diseases could infect the
vessel and cargo. During his long experience not a
single case of cholera was known to originate from
vessel or cargo. In vessels with tj'phus fever on board,
disinfection should be confined to clothing.

He would concur with Dr. Harris, that all quaran-
tine laws are vrorse than useless unless they are na-
tional in their character. Quarantine regulations are
made odious, for the reason that the subject has become
a political hobby and a source of annoyance to private
parties.

Dr. Harris would not depreciate the importance of
using vigor in the prevention of disease, if faithful men
are on guard and report truths. Dr. Walser himself
could state that, when on duty at the Health office,
strong influences Avere brought to bear to keep the
truth back, as it was for the best interests of other than
medical men to give the facts. W^hat is now needed is
a medical local organization competent to grasp the
subject.

In regard to the application of steam as a disinfec-
tant, Dr. Walser said that he applied steam in one case
for thirty minutes, and the whole veneering of the
cabin came oft'. He never tried it again.

Dr. Bell asked if the disease was not killed notwith-
standing the loss of the veneering. The destruction of
paint and veneering is of little consequence in compari-
son to the detention of vessels. The application of
steam only takes two or three hours.

He stated that the majority of merchants were will-
ing to regard the necessity of quarantine, and were
desirous of submitting the matter to inteUigent physi-
cians.

Dr. JonN C. Peters: — As regards the quarantine
of small-pox, I disagree witli Dr. Bell when he assumes

THE MEDICAL KECORD.

that mercliandise on board the infected vessel should
be disinfected; it is only necessary to thoroughly
cleanse und disinfect the persons, bed and body cloth-
ing, and baggage of the sick persons; vaccinate all
the rest, and thoroughly cleanse and disinfect those
parts of the vessel which have been occupied by those
sick with varioloid or small-pox. The cleansing of
the hair and liead of the varioloid convalescent is of
tlie greatest importance: every crust and scab should
be removed from the scalp, and the head should be
thoroughly c'eansed and disinfected before the person
is allowed to mingle with others or to land. The whole
person, head, hair, and all, should be repeatedly soaped,
washed, cleansed, and purified.

I also dissent from Dr. Bell's assumptions that the
poison of ty[)hus fever adheres to merchandise on ship-
board with any tenacity; the httle that may cling to
bales, boxes, or barrels is quickly dispersed by com-
paratively slight exposure to fresh air. But the persons,
bed and body clothing, and baggage of typhus-fever
patients require the most thorough cleansing, soaping,
and disinfection, and even steaming or fumigation is
not amiss.

I also deny that any of the cargo becomes affected
in cholera ships. The persons, clothing, baggage of
cholera patients, and those portions of the ship occu-
pied by them should be most thoroughly cleansed and
purified, as should the baggage and effects of all those
coming from cholera ports. Water closets, cuddy
holes, latrmes, and all personal conveniences, and the
sides of the vessel, should be thoroughly cleansed and
disinfected, as well as the steerage and all parts of the
ship previously occupied by cholera patients.

I am convinced that all the precautions which are re-
quired against scarlet and typhus fever, small-pox, and
cholera should be enforced against the persons, clothing,
and baggage of yellow-fever patients ; and that yellow-
fever ships should be more thoroughly cleansed, disin-
fected, and fumigated than any others; but even in
these ca^es the cargo, even if it consist of coffee, sugar,
molasses, etc., etc., is rarely or never infected. The
best way of disposing of a yellow-fever or cholera ship
is to unload its cargo as rapidly as possible, with the
full assurance that no disease will be conveyed by any
portion of the cargo to the neighboring shore. The
ship could then be very rapidly purified, and made
ready for another cargo, or could be sent off' in ballast to
the place from whence it came.

New York harbor, by the establishment of the lower
quarantine, now escapes from the greatest of all dan-
gers, that to which it had always been subjected pre-
viously, viz.. the contamination of its waters by the
presence of cholera, typhus fever, small-pox, or yel-
low-fever from ships. It is not only possible but prob-
able, as suggested by Dr. Bell, that cholera, typhus and
yellow-fever ships bring in their holds, or rather in
the spaces between their inner and outer plankings, an
enormous quantity of cholera, or yellow or typhus fever
filth which has soaked into them from the filthy docks
in which they lay while loading. Again, it is equally
true that a great deal of such filth drains down from
the decks and steerage into these inter-rib spaces, if
the disease breaks out with any intensity on shipboard.
This is pumped over the decks with the bilge water,
and contaminates the surrounding harbors and anchor-
ing places. Again, all the discharges of cholera, typhus
and yellow fever patients, and all their refuse, used to
pass, without disinfection, into the waters of the harbor,
especially into the bays and shallow places where ves-
sels at quarantine usually anchor. It is very well
known that persons bathing in these waters would
contract disease very readily ; and several instances

have become historical, in which gales of wind threw
these contaminated waters upon the Staten, Long, and
Governor's Island shores, and occasioned wide-spread
epidemics of yellow-fever and other diseases.

From the most of these dangers we are now happily
released by the removal of quarantine down below the
Narrows. It only lemains to release commerce from
the unnecessary delays, burdens, and fleecings which
have so long been mercilessly heaped upon it in the
name of Hygiene and Medical Science.

Da. W. C. Roberts, Vice-President, remarked that
the question of the contagiousness or non-contagious-
ness of yellow-fever was one of the most interesting
and practically important features in its history ; and
he sliould very much have liked to [lay before the
Academy some observations he had prepared, from
reading and refiection, on the subject. 'I'hese he hoped
to have a future opportunity of submitting to his pro-
fessional brethren.

Insusceptible, perhaps, of positive p oof, it was only
from a certain line of argument in relation to contagion,
as applied to this as well as to cveiy other contagious
disease in the catalogue, that that of yellow-fever could
be inferred.

The study of the history of the disease, the speaker
said, presented the curious anomaly of a large number
of physicians, who, having for a long time been firmly
convinced, from personal observation, of its conta-
giousness, had renounced that opinion and embraced the
opposite; of many, and most, it must be acknowledged,
who, denying its contagiousness and believing in its
local origin, looked with doubt upon quarantine regu-
lations lor its exclusion ; of men who believe in the
specific cause and nature of yellow-fever ; and of others,
again, Avho see in it little or no difference from bihous
levers of a high grade, and doubt of its specific nature.
Others, again, believe, that although originally non-
specific and non-contagious, it may, under certain cir-
cumstances, become such ; and that, even on a voyage,
the air in a dirty hold, especially with sickness on
board, might contract contagious properties. All these
views are maintained by able men, and by seemingly
convincing arguments. The contagionists affirm the
origin of the disease from infected vessels ; adduce
proofs of its communication from the sick to the well,
even in pure atmospheres; and adduce such examples,
by way of illustration, as would be deemed conclusive
in regard to any contagious disease acknowledged to be
such. The non-contagionists deny its importation, or
not, and confine themselves to showing that in nu-
merous instance-! it was not disseminated, nor caught
under favoring circumstances, etc. ; the positive asser-
tions of the one class, once the most numerous, being
counterpoised by the negative statements of the other.

Dr. La Roche, in his elaborate work on Yellow^ever,
which contains about all that has been written on the
subject, devotes to "proofs of contagion" fifteen pages,
on reading which, one would suppose the question
definitely settled; and three hundred and fifty pages
to the opposite view — showing, not what yellow-fever
did do on occasions of its occurrence, but what it did
not do. Many of his " proofs " of non-contagion are
inconclusive ; some not apposite, and some not true :
probabilities only op) :o-ed, to what others might affirm
to be clearly estabhshed facts. Upon the subject of
actual contagion he scarcely touches.

Believing the disease to be one oiiginating from
specific causes, of specific nature, distinct from others
even similar in character, and having, as he believes,
the power to show instances of personal contagion
strong enough to insure conviction in this or any
other disease of specifically contagious nature; and

THE MEDICAL RECORD.

taking into view the interesting and practically im-
portant duiractor of the investij,'ation, tUc Doctor
hoped to 1)1' iililc, at some fiiluro ])tMiod, to lay the re-
sults of his inquiiios liofore the medical profession for
a verdict on iluir merits.

Which is the safer for individuals and communities,
to admit and iict upon (he ide^ of its contagiousness,
or to disregard it and risk the eon>equences?

The President announced tliat L)r, E. G. Loring
wouhl read, at the next meeting of the Academy,
March 7. a paper on " Modern Methods of Extrac-
tion."

The Academy then adjourned.

Corrcspouticucc.

A FATUOUS PROFESSION AND INFA-
MOUS MEDICAL COLLEGES.

To THE El>ITOR OF THE MEDICAL RECORD.

Sir — Some hiy;hly respected and unquestionably honest
members of our profession read a report relative to
medical education at the last meeting of the Medical
Society of the State of New York. (See the Record for
Feb. 15, 1872, page 559.) While I entirely sympathize
with them in the objects of that report, I am convinced
that the measures thej"- propose are totally hopeless of
desired results.

Whoever pleases can sec that the report above al-
luded to adopts, and reproduces the impracticable
scheme suggested by the Committee on Educotion of
the American Medical Association, and printed nearly
three years ago. I had occasion, in my paper read be-
fore the State Society at the same meeting, to quote
from that report of the American Medical Association,
simply to show that the whole history of the subject
went to demonstrate that the plan proposed by that
report is impracticable. It is therefore to be regretted
that our State Society Committee slinuld have been
reduced to the necessity of even alluding to any such
scheme for the moral and educational elevation of the
profession.

If your readers will take the trouble to read the in-
felicitous and untruthful resolutions proposed by the
Stale Sooiety Committee (page 5G0), I have little doubt
they will appreciate the point of tlie above remarks.

Alter reading those resolutions, will any one please
to tell us how any board of censors therein provided
or contemplated can secure the attendance before them
of any proposed medical student ?

Wiiat means have Ave for enforcing the fourth reso-
lution, (see page 5G0) ? It is morally certain that
even among members of the county .societies this
resolution will be extensively disregarded;" and as to
the large number and often respectable members
of the profession not members of county societies, it
will of course be nugatory. What, for example, can
the censors do, under the provisions of this resolution,
with reference to the students of one of our most dis-
tinguished teachers who, by accident or otherwise, does
not belong, by virtue of membership, to any county
medical society ?

But the most striking failure of the report and its
resolutions is found in the complete want of any pro-
vision for the eases of medical colleges which become
so venal as for a few paltry dollars to scandalize the
honest and industrious students they may have, and
degrade and outrage professional feeling by issuing
diplomas to, or even matriculating, creatures who, in

open court, not only perjure themselves in the vilest
manner, but who declare, under oath, that lor years
they hav»; lived upon a practice obtained thiough
newspaper adverli.sements and by means of cards and
circulars of the most debased and criminal character,
distributed in the street cars.

This is by no means an imaginary ca.«e, as the fol-
lowing newspaper advertisement, of a recent graduate
of a once respectable and still prominent medical col-
lege of the city of New York, will attest:

■' Dr. . Infallible Pills lor Female Obstructions.

Twenty years' practical experience have encouraged
me to introduce an article long needed. These pills
will surely produce the desired effect, and need no
further reconmiendation.

" For sale b}' druggists generally.

" For particular information apply to the doctor's

office. No. avenue, between and streets.

Private office. No. street. From 7 to 9 p.m."

Of course, the most careful and honorable schools
are liable to imposition; but of this liability I have no
other occasion to speak in this connection than to as-
sure your readers that there was no such deception
practised in the instance above alluded to. The faculty
were fully informed in all the details of the case. They
had the phonographer's report of the declaration under
oath ; they had the original newspaper advertisements,
and they had an abundant individual evidence in sup-
port of charges of most immoral and criminal charac-
ter. Notwithstanding all this, a few dollars have,
within the last few weeks, placed the name of such a
wretch in tlie list of the graduates of one of our New
York medical colleges. No one will, of course, envy
that college its acquisition.

I have named neither college nor individual ; but I
am ready to do so at any moment the public and pro-
fessional good appears, in my judgment, to demand it.

Besides such outrageous acts, it is credibly stated
that this same college advocates the propriety, and fol-
lows the practice, of selling their diplomas to persons
living in distant parts of the State, on the simple state-
ment of the person seeking it, without any j^resenta-
tion of certificate or credentials.

The college, and the case above alluded to, are noto-
lious; and as a consequence of these disreputable acts,
its better class of students are highly indignant, and
will abandon the institution.

While honesty and morality are the best policy, they
are by no means always observed, even where it is so
clearly politic, as in the case of medical colleges.

Now, acts like that above alluded to are so frequent-
ly committed by colleges — more eager to secure a few
dollars than to shun infamy— and so Avell known by
the gentlemen signing the report, that it is a matter of
surprise they should have seriously entertained an idea
that the scheme provided in their resolutions reached,
or could remedy materially, any evil. None but the
fatuous can fail to see, that while totally venal and cor-
rupt medical colleges have control of licenses to prac-
tise, medical society resolutions of this kind will not
only be in vain, but be simple expressions of imbe-
cility. Indeed, this is so well known, that one who
moves a medical society resolution, in any other than
a strictly society matter, exposes himself to ridicule.
Outside of the society they have no significance, no
influence. This will certainly be the result of any at-
tempt to carry out the resolution referred to. (Page
560.)

But professional fatuity did not stop, at the late
meeting of the State Society, with these resolutions.
On page 558 Record, the society resolved again — to do
what? to disapprove the only even hopeful measure

THE MEDICAL RECORD.

proposed in modern times to elevate and control medical
education, viz., by invoking the strong arm of the law.
Not to say anyihing about general professional opinion
regarding this society resolution, it may be well for us
to know, that the lay opinion of it is by no means com-
plimentary to the profession. By it the State Society
has, so far as any of its resolutions could, placed the
profession before the pubhc on the same footing as the
quacks and tlie criminal practitioners of the country ;
Avhile, to our shame be it said, the ignored so-called
new schools of "pathies," have taken quite the opposite
course — have accepted the proposed measure as one
which, though it confers upon them no privileges they
do not now legally possess, gives material additional
power to be used for the public interest.
I need say no more to explain my text.

Stephen Rogers.

CEREBROSPINAL MENINGITIS.

To THE Editor of the Medical Recoiid.

Sir — The rumor that epidemic cerebro-spinal menin-
gitis has appeared in some portions of this State, and
the announcement that some cases have been reported
to the Board of Health, induces me to write a few lines,
•with the hope of calling the attention of medical prac-
titioners, who may have the opportunity of seeing this
disease, to some details of treatment, and especially to
the use of the ordeal bean of calabar, which I believe
has been of service to me in the management of a re-
cent limited epidemic.

Since the beginning of November last I have treated
forty cases of cerebro-spinal meningitis. Twenty-nine
were well-marked typical cases. The ages of my
patients ranged from 3 to IG years. Four died: and one
is not yet out of danger. As this epidemic occurred
under peculiar circumstances, and presented many fea-
tures which may be of interest to the profession, I pro-
pose to publish soon a full report.

The therapeutics of this disease are notoriously un-
satisfactory. The mortality of reported epidemics ran-
ges from 30 to 75 per cent. The death-rate of my cases
is only 10 per cent. But their number is too small to
allow any legitimate conclusion to be drawn from such
hmited statistics as to the value of any particular treat-
ment. I anticipate my report, therefore, by this pre-
liminary statement, that others may not miss an oppor-
tmiity of testing the value of the remedies I have em-
ployed.

Waiving for the present all discussion concerning the
nosology, etiology, pathology, and morbid anatomy of
cerebro-spinal meningitis, I may be permitted to state
that the most salient and central feature of this disease
.seemed to me to be an enormously increased reflex
irritability of the nervous system, with an attendant
paralysis of some branches of the sympatheticus. In
studj'ing my first case it occurred to me that calabar
bean, which ophthalmologists use in eye-diseases de-
pendent upon an irregular or interrupted innervation
of the dioptric apparatus, and which lately has acquired
considerable reputation in the treatment of various
forms of tetanus, might be of nse in this disease, the
symptomatology of which is so largely made up by
paretic and tetanoid phenomena.

At first I used the tincture of calabar bean, but after-
wards I succeeded in procuring the extract. The ex-
tract was manufactured by Hazard and Caswell, 2^
drachms of which are equal to 2 ounces of the bean.
I had one drachm rubbed up in glycerine and gave 2-5
drops at a dose.

I administered this drug in every case, as soon aa
tetanic contractions or apparent paralysis of the sphinc-
ter iridis appeared; except in two livtal cases, one of
which terminated very lapidly, the other occurred be-
fore I had obtained the extract and after the tincture
was exhausted.

In the great majority of cases the drug seemed to
exert a favorable influence upon the symptoms which
it was intended to control. In a few of tiie milder
cases, where there was rather a contracted pupil, 1 ad-
ministered atropia in pretty lull doses, without, how-
ever, influencing the general course of the disease.

In the onset of the attack the symptoms are generally
so violent, cephalalgia and rachialgia so severe and dis-
tressing, the skin and mucous membranes so congested,
that depletion seems the one thing indicated, and yet I
have resisted every temptation to abstract blood. I
have neither bled, nor leeched, nor cupped, nor blis-
tered. Ice in bladders to head and neck mitigated the
pain and proved grateful to the patient.

Cathartics I used very moderately, not intending to
produce any revulsive effect upon the bowels.

I had no reason to be dissatisfied with this treatment,
when afterward, in some of the protracled cases, a
prostration set in as extreme as the precedent violence,
and a degree of emaciation foJlowed which rivalled the
marasmus of the everlasting gastro-intestinal catarrh of
starveling foundlings.

In the first days, or whenever, in the course of the
disease, there was great restlessness, or violent jactation,
I administered moderate doses of chloral hydrate, 10-15
grains, repeated as required. Morphine I gave only in
one case where ice seemed unpleasant and headache
was worse.

Although there is a certain rhythm and periodicity in
the progress of this disease, I have seen no reason for
giving quinine until after convalescence was established,
and then, in combination with iron, it doubtless proves
beneficial in re-establishing the vigor of the system.

In most of the cases periods of coma follow or alter-
nate with spasms and jactations. In such cases I have
Ibund the iodide of potassium of service. But this drug
must be administered with a bold and liberal hand. I
have given from 2 scruples to a drachm in 24 hours ;
generally alternating it with the extract of calabar bean,
so that my patients received every two hours either a
dose of calabar (2-5 drops) or a dose of pot. iod, gr. 6-10.

Cerebro-spinal meningitis is not a sell-limited disease ;
it is protean in its manifestations ; probably more
frightful in its phenomena than severe in its anatomical
lesions, — at least in a majority of cases, — and oflers,
therefore, a hopeful field to the therapeutists, although
few victories have as yet been won. To induce phy-
sicians to make new trials I have ventured to state
briefly the method of treatment I have pursued ; so far
as its results go, I believe they are more favorable than
any that have been obtained.

In general hygiene little could be done in the persent
state of our knowledge as to the cause of the disease.
I have used carbolic acid as a disinfectant, and internally
to some extent.

In concluding these lines I wish to express my
gratitude to Piofessor Jacobi, who had the extreme
kindness to visit my patients with me, and to whose
profound knowledge of the diseases of childhood and
skilful application of modern therapeutics I am indebted
lor much valuable advice.

Very truly yours,

C. F. R0DENSTEI>f, M.D.

Westchestek, March, 18T2.

IIIK MKIHCAI. IlKCORI).

i^ctiicnl 3tcm!5 anti llcws.

CoLLKGK OK I'livsrciANS AND SuRORONs. — Thc sixty-
fifth Aiimial Coninit.'ncoiiicnt took place at Steinway
Hall. February 28. Alter a prayer by thc Rev. Dr.
llutton, IVe.^icient Delafiuld conferred diplomas upon
seveniy-eiglit <,'raduates.

Prot^ Dalton annoimced the iolluwinjr award of
prizes: —

Faculty prizes for the best two Inaugural Theses :
first prize, of fift}' dollars, to William Tiilin}.diast Bull.
A.B., of Newport, R. I., lor a thesis upon '' Perityphli-
tis ;'■ second prize, of twenty-live dollar.^, to Peter A.
E. Boctzkes, of this city, for a thesis upon "Morbus
Coxarius." The theses of the following frrntlemcn also
received honorable mention : Edward K. Ilenschell,
Xew York City. "Albuminuria;" Geoifre C. Gage,
Mobile, Ala., "Yellow Fever;" John 11. Seabury,
Jamaica, L. I., '• Acute Rheumatism ;" T. Naylor Brad-
field, Newark, N. J., "Diagnosis in Gyn;eeoIo,2y ;' and
Cornelius Gilman Trow, Sunderland, Mass., "The Ob-
stetric Use of Carbonic Acid."

Otis prize, of a case of surgical instrument?, valued at
fifty dollars, for the best report of the clinical and di-
dactic lectures on venereal diseases, to F. W. Cliapin,
of New York City.

Alumni Association prize, of four hundred d( lla's, for
the best essa}^ presented by an alumnus, to Dr. Frank
P. Foster, of this city, for an essay on " Experimental
Study of Animal Vaccination."

The subjects selected for the Stevens Triennial Prize,
of two hundred dollars, to be awarded at the Com-
mencement next year, are : 1st. "The Siihygmopraph,
its Physiological and Pathological Indications;" 2d.
" The Pathology, Symptoms, and Treatment of Con-
vulsive AfTections." This prize is open to universal
competition. The Essays must be senttc^>tlie President
of the College on or before January 1, 1873.

The valedictory address was given by Samuel Swift,
Ph.B., M.D., of the graduating class ; and the address
to the graduates by Rev. Henry Ward Beecher. Some
extracts from our notes of the latter, which we had
proposed to give, are crowded out of this number.

Bef-levue Hospital Medical College. — This college
held its tenth Annual Commencement February 29th, at
tlie Academy of Music. The Chaplain of the college,
Rev. Dr. Beach, ofiered prayer, and administered the
Ilippocratic oath to a class of one hundred and twenty-
nine graduates, who received their diplomas at the
hands of the President, Dr. Isaac E. Taylor.

Prof A. B. Crosby, M.D., addressed the graduates.
He counselled them to consider their studies but just
begun, and to pursus them not only with reference to
the particular profession they had now entered, but
quite as much with a view to that broader culture
without which even their special department, however
earnest their devotion to it, must be imperfectly com-
prehended in some of its most important relations. This
culture must extend to the heart as w^ell as to the head;
nor must they neglect those social amenities and graces
of manner whose absence might cheat the kindest
feelings and the highest skill out of the best opportu-
nities for their exercise. If tiiat personal magnetism
by which some men bring us irresistibly under their
influence was not a thing to be acquired, still every
one might learn to make his presence agreeable ; and
the phyrieian would often leave behind him a more po-
tent remedy than his prescription, in the memory of a
bright greeting or a happy joke.

In the illness of the valedictorian, Benjamin L. Lo-

throp, A.B., M.D., liis address was read by Dr. Wil-
liam Car:'. Excellent nm.'^ic was furnisheil by an or-
chestra under Carl liergmann's direction.

Medical Dki'Ahtment of the T'.niversitv ok New
York. — The annual commencement of thi.s Medical
College was held on Tuesday evening, Feljruary 20,
1872, at Ciiristian Association Hall, which was filled
with a .«elect audience. The exercises were opened
with reading of the Scriptures by Rev. Prof Benjamin
N. Martin, D.D. Rev. Isaac Ferris, D.D., LL.D.,
Emeritus Chancellor of the University, olTered prayer.
Prof. John W. Draper, M.D., LL.D., conferred the
degree of M.D. on seventy-five graduates. Certificates
of Honor were given to eighteen graduates who had
attended the spring, autumn, and winter courses of in-
struction. The Mott gold meilal was awarded to Dr. J.
V. Granger for the best anatomico-surgical jjrepara-
tion ; the Mott silver medal to Dr. H. C. Munroe for
the .second best anatomico-surgical preparation; Prof.
William H. Thomson's prize to Dr. L. P. Ensign for
the best record of his clinics; I'rof Charles A. Budd's
prize lo Dr. G. H. Hammond for having passed the best
examination in obstetrics; Prof. D. B. St. John Roosa's
prize to Dr. J. A. Ste])hens for having passed thc best
examination on the eye and ear ; Prof. F. D. Weisse's
prize to Dr. H. S. Yanderhoof for the best recoi^ds of
his clinic on skin diseases.

The valedictory address to the graduates was given
by Prof. William Darling, which was interspersed with
amusing and interesting hints. Dr. R. J. Brevard,
of the graduating clas.s, delivered the closing address.

The New Health Officer. — The following letter
has been ad(h-essed to Dr. S. 0. Yanderpoel, the newly
appointed Health Officer : —

New Yobk, Febniai-j- 28, 1872.

S. Oakley Yanderpoel, M.D., Albany.

Dear Sir : — We have heard with the greatest satis-
faction of your nomination by the Governor as Health
Officer of the Port of New York. We regard it as
most fortunate, for the credit and interests of all con-
cerned, that the above office should be filled by an in-
cumbent like yourself, fitted, by every personal and
professional qualification, to perform its duties in the
best possible manner. Possessing, as you do, the entire
confidence and esteem of the profession, your confirma-
tion and acceptance would be received with universal
satisfaclion. (Signed) Edward Delafield, M.D. ; John
T. Metcalfe, M.D. ; Isaac E. Taylor. M.D. ; T. Gaillard
Thomas, M.D. ; A. Clark, M.D.: \V. H. Yan Buren,
M.D. : Willard Parker, M.D. ; Alfred L. Loomis, M.D. ;
William Detmold, M.D. ; T. M. Markoe, M.D. ; A. Du-
bois, M.D. ; Austin Flint, M.D. ; Chailes A. Budd,
M.D. : J. C. Dalton, M.D. ; John J. Crane, M.D. ; H.
B. Sands. M.D. ; C. Henschel, M.D. ; John G. Curtis,
M.D. ; Edward Fowler, il.D. ; George A. Peter.=,
M.D.; E. R. Peaslco, M.D. ; W. H. Draper, M.D. ; L.
Ranney, M.D. ; John O. Stone, M.D. . Gustavns A.
Sabine, M.D.; C. F. Hey wood, M.li. ; Henry D.
Noyes, M.D.

Lostorfer's Syphilitic Discovery. — Professor Wedl
contests the discovery of pecuhar bodies in syphilitic
blood, and asserts that they are only mas.ses of fatty
particles and protoplasm, which are found in healthy
blood.

Deaths from S.mall Pox in the seventeen ehiefest
towns in Great Britain, during the year past, amounted
to the number of 13,174.

The Census of Rome. — The census of Rome, just
completed, shows ^ population of 240,000.

THE MEDICAL RECOKD.

©rigiital Communicationsi.

SOME DETAILS IN THE PATHOGENY OF
PY.EMIA AND SEPTICEMIA :

REMARKS BEFORE THE MEDICAL LIBRARY AND JOURNAL
ASSOCIATION OF NEW YORK,

By MARYC. PUTNAM, M.D.,

LECTURER ON MATERIA MEDICA IN THE WOMAN'S MEDICAL COLLEGE
OF THE NEW YORK INFIRMARY.

As I understand the object of this Association, it per-
mits its younger members to submit the questions tliat
may have especially interested them, to the judg-
ment of otliers older and more exiDerienced than them-
selves. This is why I venture to make some remarks
on a subject, vv^hich a rather prolonged sojourn in the
hospitals of a great metropolis has Ibrced most promi-
nentl}- upon my own attention,

Tlie study of putrid and purulent infection, though
it originate in the province of the operative surgeon,
immediately rises into the sphere of general pathology,
and touches upon problems of the keenest interest to
the physician. Moreover, by a singular fatality, the
metliods adopted to remedy the effects of accidents,
expose to many of the same dangers as the accidents
themselves ; and operations for many diseases of inter-
nal origin accumulate upon the unfortunate patient the
additional perils of an external traumatism. Finally,
while men are more especially exposed to the superflu-
ous traumatisms of war, women are compelled to incur
the inevitable traumatism of childbirth; and the ulti-
mate danger is in many cases the same.

To judge by certain assertions, one might suppose
that this danger had been so much diminislied by ap-
propriate treatment, that it now presented no more
practical interest than that of the plague. The ad-
mirers of Professor Lister have far surpassed his own
confidence' in the virtues of carbolic acid. In the
Dublin Quarterly for 1869, Mr. McDonnell affirms that
treatment by Lister's method has attained 'perftction ;
and that when a wound has been dressed with carbolic
acid, and its arteries secured by torsion, it is almost
certain to heal easily, while tlie temperature of the
body does not rise above 100°. Lister himself,
in his famous paper published in the British Medical
Journal for 1867, is not so sanguine. Pie gives no
statistics, but observes that since the employment
of carbolic acid for the dressing of wounds, his
wards, formerly the most unhealthy in the Glasgow
iofirmaiy, have become comparatively healthy, and
that he no longer dreads, as before, the advent of com-
pound fractures. In St. George\'i Hospital Reports for
1868, Mr. Holmes gives the result of experiments
made with carbolic acid in forty cases. Lacerated
wounds and abscesses did remarkably well under this
treatment; all recovered. Of eight cases of compound
fracture, four recovered and four died — tv/o of pyaemia,
one of tetanus, one, on fourth day, without metastatic
abscesses, tlie case being complicated with renal disease.
Mr. Holmes had twelve cases of incised wounds and
operations, including two amputations of the breast, but
only two involving section of the bones. One of these
was a Chopart's amputation of the foot; patient re-
covered after an attack of erysipelas ; the other, an
amputation of a metacarpal bone, followed by death
from pyaemia. In this case the patient had diseased
kidneys.

In the last October number of the Archiues de Mede-
cine, Dr. Labb6e reviews the English statistics, and
points out that, even in Lister's wards, the results of
carbolic acid treattnent are much less brilliant than
was at first supposed. Thus, i)revious to tliis treat-
ment the deaths after amputations were 41 to 120, or
1 in 3; after its adoption, they were oO in SO cases,
or 1 in 2.6. During the last six months Dr. Labb^e
had extensively employed carbolic acid, with ilie most
scrupulous attention to the details insisted upon by
Lister, and nevertheless nearly all his ; mputated pa-
tients had died. This lugubrious statement corresponds
entirely with the I'acts that I have had an opportunity
of observing closely. For at least three years the use
of carbolic or jihenic aciil has been almost universal in
the great surgical wards of the Paris hospitals ; but the
mortality has not been notably niodi0ed, and remains
higher than that of London.

These remarks, with no pretension to statistical
value, are merely intended to show that the antiseptic
treatment is by no means infallible. The phenic acid
of the moderns is not a panacea, any more than the
famous sage of the ancients. It follows that the doc-
trine upon Avhich its employment is based, is not
sufficiently comprehensive to include all the cases to
which it is applied. This doctrine is sometimes an-
nounced in a proposition that rather unfairly combines
the opinions of Poser on miasms, and of Pasteur on
animal germs. It is sometimes said that these germs
constitute hospital miasms, and act either directly, be-
ing themselves absorbed into the blood, or indirectly,
after having determined the putrefaction of traumatic
fluids. The absorption of fluids thus putrefied is suffi-
cient to account for the most various surgical accidents —
phlebitis, erysipelas, pytemia, septica3mia, hospital gan-
grene. In virtue of the assumed unity of their ictiology
and of their nature, these several alTections are asserted
to be equally amenable to a single mode of treatment.
This consists iil'the destruction of animal germs, first in
the atmosphere, b}'' purification of the air ; second, upon
the wound itself, by dressings with carbolic acid.

But, in the first place, the animal germs to which
Pasteur attributes the mechanism of putrefaction do
not exist merely in impure air, but even in tolerably
pure air, unless it be absolutely free from animal or ve-
getable dust — such air, indeed, as may be brought from
the summit of Mt. Blanc. To prevent putrescible sub-
stances from putrefying, it has been shown necessary to
seal them hermetically, so as absolutely to exclude air.
Donne experimented on an egg, which he caiefully
enveloped in cotton wool, and then obliquely jjierced
by a knitting-needle, previously heated to destroy any
germs that might be clinging to it. By means of this
puncture air was admitted to the interior of the egg,
but only after having been filtered by the passage
through cotton. The egg putrefied, as it will not do if it
be covered with an impermeable varnish. But Pasteur
asserted that the precautions taken had not been suff.-
ciently severe ; that it was possible to admit some of
these ubiquitous infusoria during the manipulation of
the experiment. How much more, then, in any Avound
not treated by absolute occlusion !

In the second place, the researches of Bechamp ai.d
Estor, communicated to the Academic des Sciences in
1808, indicate that, though the access ofair be esseniial to
putrefaction, yet the presence of bacteria in animal pu-
trefying substances does not depend on their introduction
from without, but on the development of germs already
contained in the elements of the tissues themselves.
Especially in the cells of the liver, both in man and in
other animals, these observers have discovered certain
spherical granules which they call microzymes. These

THE MEDICAL llECDliD.

rcMiain i^phcricnl as lonp as the organ is in licaltli, and
constitute a normal, necessary part of its elements.
But ■\vliin tlie tissues arc separated from tlieir vital
connections and exposed to the air, these pinnules at lirst
arranjre tliemselves in strings, and finally assume the
shape of moving or motionless roils, presenting all the
appearanre of the vihriones known as bacteria and bac-
toridia, and described by Daraine.* Fragments of
liver placi'd in water containing either sugar or starch,
showed a development uf bacteria in twenty-four hours.
But if immersed in ordinary water, the development
•was delayed five to tliirteen days. Further, what is
extremely important to notice, the addition of creasote
or of phenio acid in no wi.se afleeted this prohferation
of animal germs, unless it were made in a quantity suf-
ficient to coagulate animal tissues. Tiiat these bacteria
came from the microzyme-5 into which tliey were seen
to grade, iind not from the suirounding air, .seems proved
by the fact that they were always discovered in the
fragments of tissue before they appeared in the water
in which these were immersed.

In the QiimierJ;/ Jotirnal of Microscopical Science for
last October, Burdon-Sanderson has shown, by most
c.irefid experiments, that the microzymes never come
from the air. According to this writer, they frequently
abound in water, so that a drop or two of ordinary
spring water added to a test solution is sufficient to de-
termine in it the development of microzymes and of
bacteria. But if the water so added be boiled and the
whole placed in a gla-s that has been superheated, no
microzymes will appear, even though the liquid be left
exposed to the air. In the latter case, however, toru-
la-cells appear in as great abundance as if the liquid
had not been boiled. It is thus shown that no connec-
tion exists between the microzymes destined to develop
into bacteria and the torula-cells that multiply into
fungi. The air is charged with these latter, while the
former abound in animal and vegetable solids and fluids.

To test the influence of bacteria, apart from that of
the morbid fluids with which thej^ were a.ssociated in
Davaine's experiment-, Leplat and Jaillard t injected
the veins of animals with fluids containing bacteria ob-
tained from decomposing vegetable infusions. Such
injection- were productive of no inconvenience what-
ever. Analogous experiments were made by J. G.
Richardson, as related in the American Journal of
Medical Srimces for July, 18G8, p. 291. He swallow-
ed from one to four fluid ounces of Avater, rendered
putrid by two or three days' contact with meat, and
swarming with vibriones. A drop of blood drawn
half an hour after the ingestion of one fluid ounce, pre-
sented only a single vibrio. But Avith a k'ger dose
and an hour's interval the number greatly increased.
Twelve were seen in as many minutes, and at one time
there Avere three in one field. In tAvo hours, however,
these had entirely disappeared, their presence in the
blood having occasioned no other inconvenience than
plight headache, furred tongue, and some diarriioea.

Thus, left to themselves in contact with healthy liv-
ing tissues, vibriones are rapidly eliminated without
causing any damage. MoreoA'cr, as Davaine observ^es,
in a medium composed of substances in full putrefac-
tion, these animalcula are also unable to sustain life.
They live upon organic matter that is just beginning to
decompose ; they eannot determine the decomposition
of living tissues ; their germs cannot develop to the
potency of bacteria unless they have free access to
oxygen ; finally, when the organic matter in Avhich
they are imbedded is dead, and I'csolved into inorganic

* Dictlontiaire des Sciencen Medfcales, Art. " Bacteries."
t Comptes Rendus de FAcademie des Sciencen, 18G7.

elemenl.s, the vibriones die too. Hence, though Feltz
and Cohn have discovered tln-m in the fluids of putre-
fying Avounds ; though Ranvier hns.found them nea?'
the seat of a fractured bone affected Avith osteo-myelitis;
though he has further found germ -granules in meta-
static ab.scesses, — yet these marvellous little orgaidsms
cannot be rendered directly chargeable for all the acci-
dents of putrid and purulent infection ; nor their de-
struction be considered an assurance of security against
these formidable complications of Avounds. For, Ist,
in air that has been sufficiently purified to avert cer-
tain forms of disease, as hospital gangrene and the
more malignant kinrls of septica?mia, the germinal mat-
ter of vibriones is still found in considerable abundance,
so that animal fluids or tissues exposed to the air ne-
cessarily decompo.se.

"id. I'ositivc experiments have shoAvn that Ixacteria
by themselves, though introduced into the blood, are
not injurious. Further: Bergmann has shown that the
dried residue of pus retains its toxic properties, though
it have been heated to 212', or treated by alcohol of 96
per cent. ; and either procedure is accounted suflQcient
to destroy animal germs.*

The above-quoted experiments of Burdon-Sanderson
tend to show that the vibriones of the air, which are a
cause of putrefaction, dilTer essentially from the micro-
zymes of nnimal fluid:^, whose development may be
only an effect. But the deA'clopment of these latter
to bacteria may act like that of all other vibriones, in
favoring putrefaction. Hence the accession of air to a
wound woidd work in tAvo ways: it Avould admit at-
mospheric germs, demonstrated agents of putrefaction;
and it Avould furnish the oxygen requisite for the de-
velopment of microzymes, probable agents of putrefac-
tion. The one and the other class of vibriones — innocu-
ous if themselves absorbed — only act by determining
the alteration of traumatic fluids ; and these once alter-
ed become toxic, though the causal germs be excluded
or destroyed.

That the accidents resulting from Avounds depend
upon the introduction into the economy of substances
formed uptm them is shown : (a) because the artificial
introduction of these same substances, by injection into
the veins, is followed by the same symptoms as occur
spontaneously Avhen they are left long in contact with
living membranes ; (h) because direct expeiiiuent proves
that the capacity of absorption from the surface of
Avounds is very great.

Two gieat classes of infection may be formed: 1st.
That Avhich depends upon primary absorption from the
wound previous to the groAvth of gramdations or the
formation of pus; 2d. That which supervenes after
suppuration, and the complete disappearance of trau-
matic fever. » The first class constitutes septica3mia ; the
second, pya-mia, or purulent infection.

It is noteworthy that septicaemia is developed at a
time Avhen absorption from the wound is slowest;
pyaemia, Avhen it has begun to be most active. De-
marqua}' has shoAvn that an iodic solution placed on a
lecent wound will be absorbed in from fifteen minutes
to an hour. But after application to a granulating
wound, iodine may be detected in the urine and saliva
in ten, eight, six, or even four, minutes. It would seem,
therefore, that the accidents of septica;mia depend on
the absorption of some substance more diffusible than
that Avhicli is the origin of pysemia, since it acts more
quickly, though at a time Avhen absorption is less
active.

The Avounds in which pure septicsemia originate^ may

* On this last point, however, there is at least room for doubt, since
Wyman's experiments (A7n. Jour. Set., 1867) have shown that certain
infusorial germs will retain their vitality even after four hours' boiling.

THE MEDICAL RECORD.

affect exclusively the soft tissues. Thus, in wards where
pyoemia was the most frequent disease, I have seen
septicaemia develop as a consequence of an operation
for a double prolapsus of the uterus and rectum, where
an attempt was made to extend tlie perinanim b;ick-
wardfi by a suture that sliould include a part of the
enormously distended anal sphincter.

Septicajmia is frequent after operations for stranf^u-
lated hernia or the extirpation of tumors, and often
complicates the peritonitis occasioned by ovariotomy.
But in wards where pyi\;mia and septicemia were both
endemic, I have been struck with the exemption of pa-
tients wlio had suffered amputation of the mammary
gland. On the other hand, the extirpation of a fibro-
plastic tumor from the deltoid muscle was followed by
a typical development of septicaemia. The traumatic
fever set in within twenty-four hours after the opera-
tion, and, instead of abating, persisted, and gradually
rose into all the violence of the septicasmic fever.

This form of surgical fever is frequent as a conse-
quence of diffused acute phlegmon of cellular tissue,
even when this is unaccompanied by osteo-myelitis.
It constitutes those peculiarly malignant forms of puer-
peral fever where death supervenes with great rapidity,
and where, after death, the uterus presents no trace of
phlebitis or of lymphangitis. These cases are excep-
tional.

It is a very remarkable circumstance that gunshot
wounds, so excessively dangerous when they affect
the bones, are so frequently innocuous when confined
to the soft tissues. I had abundant opportunity for
observing this fact in the case of numerous shell
wounds that came under my observation during the
siege of Paris. In wards where acute diffused phleg-
mons frequently proved fatal by generating septicaemia,
flesh-wounds caused by the explosion of shells healed
readily, even though, as in one case, the victim was a
woman six months pregnant, and miscarried after a
triple injury in face, thigh, and leg.

A curious case of impunity, even though the bone
was involved, was that of another woman Avho had
been for four years an inmate of the hospital on ac-
count of chronic rheumatism in shoulder, Avrist, and
knee-joints, all of which were more or less completely
ankylosed. During the bombardment, a sliell exploded
in the hospital ward, and carried off this patient's right
arm about three inches below the shoulder-joint. It
was a very clean amputation, with very slight htemor-
rhage ; and but little trimming of the wound was need-
ed to make a neat stump, which was speedily covered
by fleshy granulations. Not merely did the patient
escape without any signs of septicaemia or purulent in-
fection; she even had no traumatic fever. I attributed
this remarkable exemption to the pre-existence of
chronic adhesive inflammation, which had rendered the
tissues — lymphatic, cellular, osseous, and to a certain
extent even the veins — impermeable to the septic ma-
terial arising from the traumatism.

The behavior of gunshot flesh wounds resembles
that of those made Avith caustics as compared with
those made by the bistoury. It is not my province to
insist upon the practical advantages of the method so
eulogized by Maisonneuve, but their bearing upon the
theory of septic and purulent infection is of importance.
The facts tend to show that tissues kihed outright, by
chloride of zinc or the actual canter}', present far less
chances of infection than those that die slowly and,
during a long period, offer to absorption the successive
products of their decomposition. Tliey appear, more-
over, to block up the roads of absorption, and not to
afford the media for diffusion constituted by loose dif-
fluent tissues.

Septic absorption occurs to a greater or Jess extent
whenever decomposing animal matter is brought in
contact with living me[nbranes, and seems to be inde-
pendent of the state of the veins.

The condition of the lymiihatics is of much more
importance. For at the lime that septicaemia develops,
the lymphatics, torn by the traumatism, gape open into
the wound, while later they are closed by Hesliy granu-
lations. Septicaemia, which precedes the formation of
these granulations, likewise, in typical cases, precedes
the formation of pus. This does not normally occur
before the third da}'; and if symptoms of septic poison-
ing have appeared previous to its establishment, sup-
puration may be indefinite!}' delayed, or the pus be le-
placed by a thin sanious liquid, in which pus-corpuscles
aie rare. According to Robin, the decomposition of
pus is always a consequence of the generalized infec-
tion, and not its cause.

As might be inferred from this appaient connec-
tion with the lymphatic system, the full develop-
ment of septicaemia is often preceded by a lymphangitis.
But it is extremely curious to notice that, should this
lymphangitis be inmiediately followed by tumefaction
or phlegmon of the nearest lymphatic glands, or by an
attack of erysipelas, the general infection seems to be
averted. I have in my notes three eases of compound
injuries of the fingers, followed by abscess in the
axilla, Avhich in one case had been preceded by a subacute
phlegmon of the arm ; in another, by the red streaks
of superficial lymphangitis ; in the third, by a probable
affection of the deep lymphatics. All these cases re-
sulted in recovery, in the same wards Avhere patients
affected with quite similar injuries were constantly
succumbing with symptoms of septico-pytemia. The
occurrence of erysipelas seems also frequently to
ward off the graver affection. In two cases of carbun-
cle treated by extirpation, the occurrence of a chill,
in connection with a sudden drying and glazing of the
wound, was regarded as an ominous forerunner of
Septic infection, until the advent of a local erysipelas
unexpectedly changed the prognosis. In another case,
an operation for strangulated hernia in a woman was
followed by an attack of erysipelas on the face, from
which the patient recovered. She subsequently suc-
cumbed to exhaustion, but never presented either
symptoms or lesions of putrid or purulent infection.
These fivcts, and certain statistics showing the epide-
mic alternation of erysipelas with gr-aver surgical aftec-
tions, bear testimony" in favor of the theory that ascribes
erysipelas to a diffused inflammation of the lymphatics
of the skin, caused by the passage through them of irri-
tating substances. It is upon this theory that Maison-
neuve has based his treatment of erysipelas by appli-
cation of a blister directly to the inflamed surface, for
the purpose of drawing off septic material in a profuse
discharge of serosity.

The "succession of symptoms in septicremia gen-
erally occurs as follows : The traumatic fever, instead
of abating, persists, or abates only imperfectly. The
suppuration, that should have set in on the third day.
is delayed ; and sometimes the wound becomes glazed
and dry, or points of gangrene appear in tissues that
seemed at first sufficiently vitalized. Sometimes, as
was the case with the patient submitted to a perina.>or-
rhaphy, a fugitive local erysipelas appears, to disap-
pear after a few hours. About the fourth day occurs
a single chill, often quite violent, immediately follow-
ed by a notable lise of temperature. By the fifth day
the sutures in the wound give way, and the tissues
begin to melt down into an increasingly putrescent
detritus. At the same time the pain of the wound is
diminished, and this local blunting of the sensibility

THE MEDICAL RECORD.

rapidly extends to tho entire nervous system. The
patient becomes absorbed, indifferent, finally agitated
and delirious. The delirium is sometimes muttering,
oIUmi violent. The fever is remarkable for iUs eontinu-
aiiei- ; uiorninc^ remissions are slip;ht. Under this eon-
tinued fever tlic body emaciates; tlic clieeks become
excavated, and covered with a dry parched flush ; the
eyes are injected ; tho tongue and lips retracted and
blackened ■with fidiijinositirs; the whole aspect of the
patient recalls that of typhoid fever, and the occurrence
of diarrhoea completes tlie resembhinee.

The peculiar circumstance about the jjathological
anatomy of pure sei)tic8emia is its negative charac-
ter. There is no trace of phlebitis, thrombi, or me-
tastatic abscesses. The veins arc all permeable, but
filled with diflluent black blood like molasses. The
viscera are neaily all soltened and congested, as in
typhus.

In artificial sejiticajmia, induced by the injection of
putrid matters into the veins, there is often diffused

f)neumonia, cr there may be patches of gangrene in the
lings. The most notable lesion, however, exists in the
intestinal mucous membrane, which is tumefied, hyper-
aemic, and soltened. This lesion corresponds to the san-
guinolcnt diarrhoea, which is an invariable symptom
during life, and both lesion and symptom point to an
effort at elimination of tlie poison by the intestinal
tube. That the lesion is so extremely marked in ani-
mals, while it is slight or Avanting in human victims, in-
dicates that tlie effort at elimination is greater in the
former case than the latter, and helps to explain, there-
fore, the greater resistance of dogs to the disease.

Finally, a very notable peculiaritj^ of septicnemia
is its variable degree of intensity — variable as the con-
ditions which may give rise to it. There is the terrible
septicemia of malignant forms of puerperal fever, that
destroys life in a few days; there are the much milder
Ibrms, t'.iat almost invariably occur when decomposing
animal fluids are brought in contact with any surface ot
the body in such a way that any part of them may
be absorbed. The retention of a piece of the placenta
in the uterus will give rise to all tho symptoms of an
incipient septic fever, as I had an opportunity to observe
in a ease the other day. Nay, even in perfectly normal
conditions, recent accurate observations have noted a
rise of temperature as a general occurrence about
twelve hours after parturition. This phenomenon is
precisely analogous to the well-known traumatic fever,
and the elementar}- conditions are the same, namely,
the contact of decomposing non-purulent fluids with
living membranes capable of absorption.

In these cases, the general disease seems to be
directly connected with the wounds, and this, not in
virtue of the nervous shock they have inflicted, but of
t'm decomposing liquids, or of some element in them,
that they place in contact with live animal membranes.
The essence of the general disease lies in the fever, or
rise of temperature; and of all the causes that have
been invoked to explain the rise of temperature in such
cases, that of an acceleration of the molecular metamor-
phoses of the blood and tissues is infinitely the most
probable. For the fever may be determined, either,
as I have said, by contact with animal membranes
of substances themselves undergoing rapid chemical
metamorphoses, or by an injection of these same sub-
stances into the blood, as in Billroth's experiments.*
In these experiments there was no chill, but tlje tem-
perature rose immediately as liighas 40.5" C, and other
symptoms of septicaemia followed, as diarrhoea and
great prostration. Recovery frequently took place.

' Archiv far Klinische CMrurgie, 1862.

In some cases, where the amount of injected material
had been very large, death occurred, and then the
only visceral lesions discoveral.lc were diffused conges-
tions, especially of the inU'slinal mucous membrane.
From these experiments the gravity of septicasmia
is .«hown to be in direct ])roportion to the amount of
putrid nuUters thrown into the blood, although in every
case they determined a rise of temperature. IJelow a
certain limit of (paantity, they could be supported; but
above that limit, they occasioned more violent symp-
toms, which finally proved fatnl. This gradation corre-
sponds to that furnished by clinical experience — to the
immense variety in the severity of septicaemic symp-
toms, which are least of all after normal parturition ;
greater alter wounds, and in proportion to their extent ;
greatest of all when, long alter the original shock, new
tissues have sloughed by the invasion of hospital gan-
grene. There are, therefore, the strongest reasons for
accepting the recent doctrine of I3illrotli, which inter-
prets traumatic fever as a form of septicaemia, and .septi-
caemia as a simple extension or aggravation of traumatic
fever.

Tliis analogy suggests that of numerous other affec-
tions in which septicemia pla3's a prominent part, as
hospital gam^rene, carbuncle, malignant pustule, typhoid
fever, variola, ulcerative endocarditis, even erysipelas
when the effort at cutaneous elimination has proved
unsuccessful. In all these cases the evolution of the
affection seems to be connecteil Avith the presence in
the blood of rapidly decomposing substances, whose
metamorphoses accelerate those of the animal tissues,
including the blood, and thus raise the temperature of
the body.

It is in virtue of this rise of temperature that septicae-
mia is allied to pyaemia; lor the injection of pus into
the veins, even when it produces no other effect, gen-
erates fever as intense as that jiroduced by the injection
of putrid non-purulent fluids — fever which may end in
death. In other resjiects the symptoms and march of
pyaemia are quite different from those of septicaemia.

As every one knows, pyajmia originates most fre-
quently in some lesion of bones, which places the
wounded osseous tissue in immediate communication
with the air. The larger the bone, the greater the
danger, which is most to be dreaded after injuries of
the femur. Who is not liamiliar with the train of events
that, in such a fatally large number of cases, follows
upon an amputation of the thigh? The patient may
have recovered from the initial traumatic fever, and
on the fourth or fifth day be apparently in very good con-
dition. Suppuration, which set in on the third day, be-
comes profuse, but the pus remains thick, yellow, lauda-
ble, or only slightly offensive in smell. Thus, suppura-
tion precedes the invasion of pyemia, while the symp-
toms of teptica^mia generally begin before the establish-
ment ofsuopuration, or arrest it if pus be already form-
ed.

The wound is extremely painful, and its sensitiveness
seems to increase instead of diminishing. The process
of dressing the wound throws the patient into an
agony ; but when this is over, he is comparatively com-
fortable, often extremely hopeful and sanguine. One
day, generally between the fifth and tenth, the nurse
observes that the patient has eaten less than usual. In
reply to inquiries, however, he asserts, sometimes quite
vehemently, that he is perfectly well. A day or two
later he acknowledges having had a slight chill or
fever, that he refers to only on account of the persistent
questionings of the surgeon. Sometimes several days,
even a week, will elapse before the chills are repeated ;
sometimes they follow in rapid succession, coming
every day, or even twice and thrice a day. It is ex-

THE MEDICAL RECORD.

tremely rare that only one chill precedes the invasion of
fever ; and even then, this invasion only occurs after
a certain interval. The chills are very apt to return
after the establishment of fever, and checker its course
in a way never seen in pure septicajmic infection.

The rise of temperature occurs sometimes after tlie
complete subsidence of the traumatic fever, in notable
contrast witli that of typical cases of septicaemia. It is
rarely as rapid, as intense, or as continued as in the
latter case ; for some time it presents very marked
morning remission, and only gradually rises into con-
tinuity.

The appetite and strength fail, and the patient is
conscious of his increasing weakness, and complains of
it, as is never the case in septicjemia. Hence it seems
much more notable. The skin and sclerotics assume
the characteristic yellow hue, extremely unlike the red
parched flush of septicaemia, and analogous to that of
cancerous infection, with which Bihroth compares it.
It is one of the forms of jaundice described by Gubler,
dependent on a destruction of red corpuscles in the
blood. The tongue of the patient becomes dry, but
never blackened by fuliginosities as in septicaemia. The
intelligence remains clear, but the mind begins to be
darkened by gloomy forebodings, by a semi-conscious-
ness of the dissolution of vital forces already begun.

During this time the aspect of the wound is little
changed, the suppuration is abundant, according to
Billroth is increased, and my own observations accord
with this statement. An extension of suppuration
takes place, as the older writers would say, and is mani-
fested in one or more of three different ways.

In the first place, cold abscesses may form in differ-
ent parts of the cellular tissue, generally of the extremi-
ties, sometimes in the more decumbent portions of the
trunk. In the second place, purulent eflfusions njay
take place into the articulations, or serous cavities, and
that with extraordinary rapidity. This pin'ulent ar-
thritis is a very common manifestation of infection dur-
ing the puerperal state. I remember one case especiall)^,
which I had an opportunity of observing at tlie cliniqne,
that might be considered as a type of this class. The
patient had had an attack of subacute metritis, wiiich
was subsiding, when she complained of pain in her It-ft
elbow-joint ; and in the course of tweniy-four hours the
articulation became evidently filled withlic[uid, swollen,
extremely tender, but without any inflammatory red-
ness. The only other symptoms presented by the
patient v/ere diarrhoea, and a certain dulling of the in-
telligence. M. Depaul immediately pronounced a fatal
prognosis, which was justified four or live days later by
the death of the patient with all the symptoms of
purulent infection.

These external suppuration-s, however, indicate a com-
paratively curable form of the disease, and, when mani-
festations of the infection are confined to the cellular
tissue or the articulations, the patient may recover. I
have seen three curious cases of this categor3^ After
a compound fracture of the tibia, a patient was affected
with cold cellular abscesses in various parts of the body,
and with purulent effusion into one of the knee-joints;
yet he ultiuiately recovered.

In anotlier ca^-e, also of compound fracture of the
tibia, the patient had had three chill--, and an abscesr;
had developed in the thigh. After the administration
of quinine, the course of the infection seemed to be
arrested, and the patient recovered.

In a third case, the purulent infection had origi-
nated in an anthrax, which had been followed by
abscesses in the breast, gluta^al region, and leg, and by
an effusion, probably purulent, in the knee-joint.
Notwithstanding this multiple suppuration, the patient

recovered, and the articular effu.sion was reabsorbed
with the rapidity so remarkable in such cases.

These cases recall the experiments of Sedillot upon
dog'j, where injeclion of pus into the veins was fol-
lowed by the development of external abscesses, but
finally by recovery.

External suppuration or suppura'ive inflammation of
serous cavities may, however, of itself prove fatal, as in
a case that I saw at the Children's Hospital, where
purulent infection is comjiaiatively rare. A child four
years old had been submitted to Chopart's amputation
of the foot, on account of a fungous arthritis, accom-
panied by necrosis of some of the medio-tarsal bones.
The first few days after the operation passed very well;
then secondary fever set in, and was followed by sj'-mp-
toms of arthritis in both elbow-joints, and of double
pleural effusion. Death occurred about a fortnight
after the operation, and at the autopsy were found
.abundant purulent effusions in the articulations, in both
pleural cavities and in the peritoneum. This purulent
peritonitis had been latent and quite painless, and had
probably taken place during the last days of existence,
when sensibility was blunted. There were no traces
of metastatic abscesses in lungs, liver, or spleen.

These metastatic visceral abscesses constitute the third
form of generalized suppuration, and the lesion most
characteristic of pytemia. The invasion and march of
the disease seems to coincide exactly with their devel-
opment and evolution. To them is due the dyspnoea
that occurs early in the disease, while that of septicaemia,
dependent on the poisoning of the mass of the blood,
does not supervene till later. The respirations are
rarely below forty, sometimes as high as fifty or sixty.
With the progress of one or the other of these suppu-
rations, the prostration of strength increases. All the
powers of life seem to be graduall}^ dissolved apart
irom one another, and drift away separately before
sinking down into the sea of nothingness that is rising
to engulf them. Hence towards the close, a peculiar
incoherence of the mental faculties and of speech, that
is quite distinct from the delirium of septicaemia. The
patient will interpolate absurdities in the midst of a
conversation whose general tenor is reasonable ; he
has tempoi'ary hallucinations of vision ; he loses all capa-
city for comparison, and consequently for astonishment ;
his mind resembles that of a person in the incipient
stages of dementia.

This ataxia of the intelligence finally extends to the
spinal and peripheric nervous system ; there is carpholo-
gia, the wandering involuntary movements by which
the patient seems vainly endeavoring to clutch at the
life that is slipping away from him. Finally, conscious-
ness is entirely gone — the patient lies on his back with
his eyes closed, already half a corpse. I have seen one
case where this condition was prolonged a month, and
Mr. Paget relates similar cases of chronic pyaemia,
where, as in Edgar Poe's story, the patient seems to
have been magnetized when at the point of death, and
his dissolution arrested, but left constantly imminent.
It is during this last period that the suppuration on the
wound diruinishes.

The autopsy of patients who have succumbed to pyte-
mia reveals one or other of three charactf'ristic lesions,
and very frequently a combination of all of them : osteo-
myelitis ; venous thrombi, with or without phlfbitis;
visceral abscesses, or purulent effusions into the articu-
lations or serous cavities.

The osteo-myelitis, whose presence might have Ijeen
inferred from the constancy with which pyaemia is as-
sociated with lesions of the bones, is extremely fiequent.
M. Ranvier, in an article published in the Lijons Mid-
iaile for last May, observes that he found it in all the

•8

THE MEDICAL KECORD.

Riitopsies made at Val de Grace durin;^ tlie siege. M.
Gos>-^elin, ill his clinical lectures, always insisted upon
this coincidence, an<l has rt'lencd to it again in the re-
cent discu.-sion at the French Acadrmy. I have cer-
tainly had abundant opportunity to ohscrve it myself.
"* This osteitis is always of the rarclyiufj; variety; the
bony tissue is hifrldy vascidarized, and ihe surface of a
section shows the tral)ceulie to be red and softened, and
the spaces they enclose enlarged, and filled with gru-
mous sanguinolent matter. The medullar}- canal is filled
villi a vascularized pulpy mass, whence the lat has dis-
appeared, a most noteworthy circumstance. A very
characteristic detail is the projection of a portion of the
mass from beyond the medullary canal.

Of Ie?s importance for the pathogeny of pyaemia is
the thickening of the periosteum, and its frequent de-
tachment from the bone by neoplastic material formed
beneath it.

There are two noticeable facts al)oiit a bone in this
condition : 1st. That all its cavities, both the medullary
canal and the spaces between the trabeculae, instead of
being obstructed by solid clots, are filled with loose,
pulpy, diffluent matter, exactly calculated to offer a me-
dium of diflfusion for liquids carrying solid particles in
suspension, lid. That the fatty matters of the me-
dulla, so eminently adapted to rapid movements of
chemical metamorphosis, are as ready for absorption as
are the liquids on the surface of the original -wound.

Not only is osteo-myelitis an almost invariable at-
tendant on fatal cases of compound fracture, but it may
constitut,^ the sole perceptible cause of ])ya;mia, as
v/hen the latter supervenes upon an acute necrosis
(so calleii), or even, under certain circumstances, upon
sinif)le fracture. I have observed an example of py-
aemia in an old man affected with simple fracture of
the neck of the femur whicli had begun to consoli-
date when he succumbed to the afiVction, at that time
endemic in the ward. Billroth quotes a similar case;
and Prescott Hewett records a third in the Lancet for
1867.

In ano'her instance that I have seen, the pvicmia
supervened upon a chronic otitis, accompanied by caries
of th i petrous bone. In all these cases, metastatic
abscesses were formed in the lungs.

The second lesion that may be found in pyajmic au-
topsies is phlebitis. Billroth observed it twunty-eight
times in eighty-four cases. As is well known, it is to
phlebitis that Berard ascribes all the phenomena of pu-
rulent infe':tion. The apprehensions of dangi^r from this
cause have been much diminished since Virchow has
shown that the coagulation of blood in the veins is not
its consequence but its cause, and that irritation direct-
ly applied to empty veins inflames the external coat,
but leaves the inner tunic untouched. The inflamma-
tion of the inner coat is always a consequence of the
softening of the coagulum i.hat ha^ formed in the cavity.

This softening, or suppuration as it has bei n called,
takes place in two ways: 1st. By the molecular disin-
tegration of the fibrin. 2d. By the penetration into its
mass of pus ci-lls, or white blood-corpuscles, that have
wandered from blood-vessels or from purulent collec-
tioi^ in the neighborhood of the thrombus. Ilueter, in
his chapter u\^DiUro(h and PitluCs Sur;/er?/, does not
hesitate to admit this penetration, and considers it
proved: (a.) By Cohnheim's experiments on the capa-
city of white biood-corpuscles to traverse the walls of
capillaries and blood-vessels, (b.) By t'.iose of Eeck-
linghau-en, published in the Archiv of Vircliow, and
whicii show the contractility of pus cell?, and of cells
ofconnec'ive tissue, (c.) By the experiments of Bub-
nofi; recorded in tiie Centralblatt, of 1867, there has
been directly observed the passage into the thrombus

of pus cells that had previously taken up granules of
cinnabar. In this connection we may inquire whether
the presence of the granules did not communicate a
force of impulsion to the cells that they otherwise
would not have pos.sessed ; and whether, therefore, pus
cells that had become granular by commencing decom-
position, would not be able to penetrate where others
were shut out.

When, by the medium of a phlebitis, inflammation
may be propagated from the wound to ti.ssues of vital
importance, the softening of thc'clot may prove imme-
diattdy fatal. In the Ai'chires Grnh-'ihs for 1871,
Kcverdin has pointed out that in anthrax of the face,
inllamniation of the fai'ial veins may extend to the sinus
of the dura mater, and excite a fatal meningitis.

Except in such special circumstances of contiguity,
phlebitis remains a purely local affection, not only in
such ty[)ical cfises as that of inflamed varicose veins, but
also in others where it seems to substitute itself for a
general disease. Thus, during an epidemic of so-called
puerperal fever, the patients affected with a well-defin-
ed metiitis, or phlegmasia alba dolens, generally escape
peritonitis or septic infection. Even the phlebitis that
seems to have been generated by transport of pyroge-
nic material from a distant wound, may result in recov-
ery, without signs of infection. I have seen one case
where the extirpation, for cancer, of a mammary gland,
was followed by phlebitis of tlie right leg — a real phleg-
masia alba dolens, which retarded, but did not prevent
recovery. So marked is the opposition between local
adhesive phlebitis and pyaemia, that Sedillot treated in-
cipient cases of the latter disease by cmterization over
the veins leading from the wound, for the purpose of
exciting inflammation and an effusion of plastic mate-
rial that should erect a barrier against the absorption
of putrid substances, or, as Sedillot maintained, of pus.

When the fibrinous coagulum remains hard, and
obliterates the vein, no phlebitis ensues, as may be seen
in ordinary varicose veins, or in the inopexia of cachec-
tic diseases. The inflammation of the inner coat of the
vein, as I have said, only occurs when the process of
.softening of the clot has extended the cavity first hol-
lowed out in its centre, to the membrane limiting its
periphery. It is infinitely probable that this process,
which causes the phlebitis, is itself the cause of acci-
dents of which the phlebitis is only an incident, because,
on the one hand, these accidents coincide with the
softening of thrombi, when little or no phlebitis exists;
on the other hand, there are very rarely accidents with
a less degree of softening, and a very intense degree of
phlebitis.

The question of the influence of phlebitis in pyaemia
resolves itself, therefore, into two others: 1st. The
formation of thrombi ; 2d. Their disintegration.

Now it is extremely noticeable that many of the cir-
cumstances whicli favor the development of thrombi
are precisely those which seem almost essential to the
development of pyajmia. As Weber observes, since
every traumatism involves a solution of continuity of
veins, and since this is necessarily followed by a coa-
gulation of blood in their interior, the formation of
thromli is a necessary consquence of eveiv wound.
But in superficial wounds of the soft tissues, the vessels
are small, and easily obliterated at their extremities.
When larger vessels are torn, one of two things hap-
pens : Either the vessel flattens together above the clot,
obliterating its extremity, and then the thrombus never
projects into a free cavity; or the clot is prolonged as
far as the nearest collateral vessel, and its extremity
floats free in the stieam, and in a space larger than its
own diameter. When this last occurs in arteries, as is
( normally the case af er ligature, no harm result*, because

THE MEDICAL RECORD.

the sti-eam of Wood is not coming from the collateral,
but passing down into it, and if any fragments are s^epa-
rated from the fibrinous clot they must be carried
down to anotiier point on the periphery of the vascular
system. But in the case of a vein the conditions are
reversed; the coUateral current comes from the pei'i-
phery, strikes the floating end of the coagulum, breaks
off a fragment, and carries it towards the heart and
lungs.

Of the conditions which favor the disintegration of
ihe thrombus, the first, therefore, are those wliich expose
its free end to be broken ofl" mechanically. These con-
ditions are two : length of the coagulnm, and such a
structure of the tissue surrounding the veins as is op-
posed to their collapse.

The length of the coagulum is increased: 1st. By
whatever increases the amount of fibrin in the blood,
or rendei' its circulation sluggish, as abundant haemor-
rhage, exhaustion from previous disease, privation, or
old age. Weber attributes the rarity of true purulent
infection among children to the activity of their circu-
lation, which restricts the formation of thrombi. 2d.
By the absence of valves in the veins. .3d. By the
sudden suppression, through amputation, of an exten-
sive vascular territory.

The two latter conditions are presented by the veins
in the long bones, the last especially after amputation of
the thigh, where, as is known, the liability to pyaemia is at
its maximum.

In os-eous tissue, and especially in that of the long-
bones, is also found the second general condition favor-
ing long cnagula, namely, a structure that prevents
the veins from collapsing. Lining the pores of the
bones, they are necessarily maintained distended, and
this circumstance, which has been wrongly sup-
posed to imply such gaping open into the wound as
should permit the direct entrance of solid particles,
really favors the formation of lengthy coagula, with all
their consequences. The same condition may be pre-
sented by the sinuses of the uterus when that organ
fails to contract sufiiciently after parturition. Here
again are no " open mouths," but tortuous vascular
canals, in which collateral currents meet and cross
each other in every direction, filled with loose fibrin-
ous clots that offer media for diffusion, and are liable
to disintegration.

The circumstances that favor the disintegration of
the clot throughout its mass, constitute the second class
of conditions which render thrombi dangerous.

1st. First among these is the osteo-myelitis, which
Ave have already noticed as so generally existing in
fatal cases of pyaemia. The local activity of the cir-
culation, uncompiensated by sufficient force in the cen-
tral part of the system, on the one hand determines
serous effusions into the clots; on another, creates
collateral cvu-rents ready to carry down stream the
fragments resulting from the disintegration. This effect
is added to that proper to the inflammation itself.

2cl. The softening of the clot is favored by the
penetration into its mass either of pus cells already
effused elsewhere ; or of white corpuscles directly
passing from the neighboring blood-vessels; or, finally,
of putrid liquids. We have noticed that the penetra-
tion of pus cells, which could not in any wise be con-
sidered a phenomenon of absorption, would be prob-
ably favored b}'' their granular and angular condition ;
and as this is peculiar to decomposing pus, the influence
of the latter may be in part explained. As to the
white blood-corpuscles, with Avhich we have seen that
a certain proportion of pus cells may be identified, the
f;T0st common condition of their transudation is their
previous stasis in capillaries, Avhich has long been

known to be one of the initial phenomena of inflam-
mation. The well-demonstrated influence of intense
local inflammation upon the development of pyocmic
accidents, is thus in part accounted for by the pene-
tration into the interior of thrombi of pus cells existing
in the neighborhood. When such elements come fi'om
the tissues suirounding the thrombus, they penetrate it
in virtue of the contractility demonstrated by Cohn-
heim and Recklinghausen. But, if they ever come
fi-orn the surface of the wound — that is, penetrate fiom
without inwards — they are diffused like other solid
particles in the liquids which iiold them in suspension.

Since, after the closure of the lymphatics, there are
no open-mouthed vessels gaping into the wounds, and
consequently the absorption of pus as such is impos-
sible, this diffusion from the surface of the womid is
regulated by the general laws of diffusion. Thus it
will be greater Avhen there is a stronger pressure with-
out, such as may be exercised by tissues rendered
tense by inflammation or by fibrous aponeuroses, and
when this is combined with a diminution of the pres-
sure within, as by a lowered tension in the blood-
vessels. A liquid difiuses more easily when it is less
dense, and especially when it contains less colloid or
albuminous substances. Hence the thin sanious fluids
first formed on wounds may be expected to diffuse
more readily than thick pus, rich in albuiuen ; and this
corresponds to the fact already noticed, that septicsemia
precedes the formation of pns, and seeius due to toxic
substances more diffusible. A granulated condition of
the pus cells may favor their penetration. Finally,
a'icording to Sachs, the protoplasma of cells has a ten-
dency to retain the solid particles of liquids that difluse
into them, so that these grow less and less dense as
they traverse successive layers of cells. With each de-
crease of density, or diminution of solid particles, the
diflusing power is heightened, and the fluids that have
once traversed the outer barrier of tissues, pass with
continually increasing rapidity towards the interior of
central canals or vessels. The ultimate action, there-
fore, would almost necessarily be exercised by the
fluids.

The fluid invariably present in cases of purulent in-
fection, and added to the ordinary traumatic fluids
generating septicaemia, is pus. From the nniuerous
experiments that have been made by the direct injec-
tion of pus into the veins, certain facts may be consid-
ered as proved. 1st. A single injection of fresh pus
causes a temporary rise of temperature, but no other in-
convenience. 2d. This same lise of temperature may be
induced by the separate injection of either pus globules
or purulent serum. 3d. The injection of purulent
serum holding inert solid powders in suspension, will
determine the formation of pulmonary ecchymoses
and infarct! if the serum be fresh ; of pulmonary ab-
scesses if it be beginning to decompose; of septicaemic
symptoms and visceral gangrene if it be entirely
putrid. 4th. The repeated injection of fresh pus at
intervals of two or three hours will produce metas-
tatic abscesses according to Sediflot ; but according to
Billroth, who repeated these experiments, only a rise
of temperature sometimes, external suppurations, and
occasionally pulmonary ecchymoses. 5th. Finally,
the injection of putrid pus will determine a violent
septicaemia, with patches of visceral gangrene, and, in a
concentrated form, is one of the most violent poisons
known. .012 of the dried residue is sufficient to kill a
small dog.

The entrance into the economy of pus or of some cf
its elements, would seem, therefore, to act in one of
three ways : 1st. As a medium for the diffusion of
solid particles, which would block up the capillaries of

THE MEDICAL RECORD.

t!ie lungs, and thus form inforcti, acoording to the
theory of embolism. ThcJC solid pariioles could not,
however, be tlie pus globules themselves, because, iu
c'iiiie il conditions, these could never penetrate into the
blood except in very small «piaiililics, and a single in-
jection of much larger quantities of fresh pus will not
produce such cflocts. litl. Tiie pus ma}' bo supposed
to act by a peculiar alteration of the blood, such* as
oi'cwrs by repeated injections at short intervals. 3d,
Finally, it may act as a i)utrid fluid, but endowed with
toxic properties of peculiar intensity.

The tlieory of embolism, invoked fof the explanation
of metastatic visceral absce-ses, has, as every one know.s,
been snceessfully applied to the pathogeny of cerebral
and pulmonary apoplexies ; and there is no need in this
place to enter upon its details. That the ccchymoses
determined by the injections of fresh purulent serum
and inert powders, represent the initial lesion of me-
tastatic abscesses, is rendered probable by the frequent
clinical coexistence of the two, together with that of all
the intt'rmediate stages beiwecn them. Thus, in an
i:itere-;iing case of acute pysemia, laid before the New
York Patiiological Society by Dr. Janeway, the lungs,
liver, spleen, kidneys, and, extremely rare circumstance,
even the heart, are said to be studded with " minute
white spots surrounded by a red areola," evidently me-
tastatic abscesses. Tiie first stage of such abscesses was
represented in the lungs by numerous nodules of pul-
monary aporilexy ; the last, at the apex of the heart,
by two small cavities entirely filled with pus.

But the progress of such infarcti towards suppuration,
which is the characteristic fact of clinical pytemia, and
which is so difficult to reproduce in experiments, im-
plies the addition of some other element to that of em-
bolism ; for ordinary infarcti do not suppurate, but un-
dergo the fatty or cheesy degeneration. In pyaemia,
therefore, eitlier the embolus, or the liquids with which
it is impregnated, or both, m.ustbe posses>ed of peculiar
properties, and to them must be due the lobular inflam-
manon of the lungs, and the suppuration in which it so
rapidly terminates. This local inflammatory jiroperty
may be considered identical with the general pyrogenic
action that these same fluids exercise on the blood, and
both depend on the accelerated metamorphosis of tissue
and consequent generation of heat due to rapid chemical
combinations.

Difi'used suppurative inflammations are, tlierefore,
unquestionably the proximate cause of visceral metas-
\tatic abscesses ; and Ranvier, in his recent paper already
a'luded to, considers them sufficient explanation, with-
out any necessity for the intervention of embolism.
This distinguished microscopist declares that he never
found the small vessels surrounding the abscesses to be
obstructed; but on the contrary, during the ascending
period of the abscess, they were always gorged with
blcod. These negative facts prove nothing, however,
against the former existence of capillary embolics, which
disappeared in the midst of the vascular afflux their
mechanical and chemico-vital irritation had determined.
At all events, these inflammations which M. Ranvier
shows to be nodules of catarrhal pneumonia, with pro-
liferation of epithelium, are very different from the dif-
fused patches of congestion or gangrene determined by
the injection of putrid matters, whether these be puru-
lent or non-purulent. In the latter case the eflect on
the general mass of the blood overpowers the local
effect on special groups of capillaries. The lesions,
those of septicaemia, resemble those of typhus, while the
catarrhal pneumonia of pyemia resembles that induced
by injection of solid powders into the bronchial tubes.
The peculiar relations of the capillary net-work of the
lungs to the circulation, net-work which must necessa-

rily be traversed by any solid particles circulating in the
blood; the coincidence in pyiKuiin, of such conditions
as render tlie circulation of such particles highly proba-
ble; the almost universal localization of pyaeiiiic ab-
scesses in the lungs, where Billroth found them in
seventy-nine out of eighty-four cases ; the coexistence
of all grades of lesions intermediate, with ecchymoses
and infarcti, and completely formed abscesses; all these
facts indicate that the first-nameil mode of the action of
pus — that where it acts as a medium for difl'using solid
irritative particles — is one of the most characteristic,
and that w hich chiefly distinguishes it from non-puru-
lent septic fluids.

In the second place, the fact that repeated injections
of pus will produce effects that cannot be determined
by a single injection, imply that the pus may act by a
previous special alteration of the blood agam different
from that of .septicasmia. According to Sodillot, the effect
of repeated injections of pus is to accumulate its cor-
puscles in the blood, and thus block up pulmonary ca-
pillaries by a peculiar kind of embolism. But this
could not be true in clinical cases, for there the pus is
not injected directly into the veins, but its elements, if
they penetrate into the circulation at all, are diffused
gradually in too small proportions to cause mechanical
obstruction.*

Billroth admits a multiplication of the white blood-
corpuscles, and an increased tendency on their part to
accumulate in the capillaiies of the lungs, whence the
metastatic abscesses. He thus explains both the excess
of white corpuscles noted by Sedillot, and also the pe-
culiarity of the action of pus, as distinguished from that
of septic non-purulent fluids.

Perhaps it is not too hypothetical to connect this
excess of white corpuscles with the tendency to puru-
lent efi'usions in the splanchnic serous cavities and in
the articulations. These do not depend upon inflam-
mation, for that seems rather to follow than precede
them ; and thc-y may be reabsorbed with a rapidity un-
known in ordinary purulent arthritis.

"When the pus is putrid it acts like putrid fluids, and
determines not pya3mia, bijt a septicaemia of peculiar
malignanc}'. The poison generated in pus, therefore,
seems to be much stronger than that of other fluids.

Having passed in review the notable differences that
exist between septicaemia and pya?mia in regard to
their symptoms, the time and mode of their invasion,
their anatomical lesions, and their reproduction by ex-
periment, we are led to inquire whether these differ-
ences depend upon the operation of different poisons,
or of the same poison operating in diff'erent conditions.
The second doctrine is most emphatically affirmed by
M. Verneuil in tlie recent discussion at the French
Academy. He declares that pyjemia or purulent infec-
tion is to be regarded as an accidental complication of
a general disease, septicaemia, which in a mikl form, at
least, exists necessarily in the case of every open wound.
Septicaemia depends upon the absorption of sepsine,
generated in the traumatic fluids; pyiemia occurs when
this sepsine impregnates emboli that, carried to the
lungs, form metastatic abscesses, cf which each becomes
a new focus of infection.

The term sepsine, invented by Bergmann and adopted
bj' Yerneuil, represents the unknown quantity existing
in purulent or putrid hquids that gives them their pe-
culiar pyrogenic properties. Great eflbrts have lately
been made to isolate this hypothetical substance.
Panum and Hemmer have shown that it exists partly
in the serum of the pus, partly in the filtered globules.

* M. Pornariiuay has recently performed some experiments, coiisi«
dered to prove that such penetration does take place. See Archives
Generales for December.

THE MEDICAL RECORD.

It is not volatile, and cannot be distilled from pus, but
remains behind in the dry residue. An aqueous extract
of this residue is toxic, and, moreover, will ditruse
through animal membranes, and communicate its pro-
perties to pure water on the other side. Tlii-! diffusi-
bility is an eminent characteristic of the "sepsine," so
called ; and in virtue of it Bergmann claims to have iso-
lated the toxic principle from many others with which
it was associated, including inorganic matters, albumi-
nous substances, and leucine.

Direct experiments with a number of substances, as
various salts of ammonia, sulphide of carbon, solutions
of leucine or tyrosine, either produced no effect, or
symptoms cpiite different from those of septic or puru-
lent infection. With sulphide of ammonium alone,
Weber, who employed much stronger doses than Bill-
roth, obtained a notable rise of temperature and aseptic
inflammation of the intestinal mucous membrane.

Until the toxic principle in the two cases shall have
been isolated its unity cannot be considered proved.
In the mean time the following facts speak in favor of
the existence of two poisons analogous to each other,
but not identical.

1st. That non-purulent liquids, holding solid particles
in suspension, do not determine the same lesions as
purulent serum, that has first been filtered of its glob-
ules and then associated with inert powders.

2d. That the train of symptoms which occur after the
establishment of suppuration, are not merely different in
degree, but in kind from those which have preceded it.

;-id. That pus exercises an action apart from that de-
termined by its putridity.

4th. When pus is putrid it is a more violent poison
tiian other putrefying traumatic fluids. Clinically the
presence of putrefying pus is associated with the mixed
disease, septico-pyajmia. the most fatal of all surgical
affections.

5tb. The conditions of the diffusion of pus have been
shown to be different from those of primitive septi-
casmia.

Independently, however, of the probability of som.e
special toxic agent in pus, which gives a peculiar char-
acter to pyaimia, the existence of metastatic abscesses
introduces new complications by multiplying the foci
of infection. From each abscess new pyrogenic material
is continually being thrown into the blood, and when
the abscess is situated in the lungs, the material that
has been formed there is probably peculiar, on account
of the peculiar exposure to air to which it has been
submitted.

The dependence of the characteristic march of pyasmia !
upon metastatic abscesses, is shown by the insidious
invasion of its symptoms at this moment of their forma-
tion, and by its gradual intermittent progress in pro-
portion to their successive evolution. Hence tlie initial
chill uft^r the subsidence of traumatic fever; hence the
increasing violence of the chills as the visceral suppura-
tions become more numerous ; hence the peculiar dan-
ger of pulmonary abscesses so much greater than that
of even pya^mic abscesses formed in external cellular
tissue.

On the other hand, it is unquestionable that the vio-
lence of pyajmia is not invariably in proportion to the
number of pulmonary abscesses; and that in certain
cases where the first symptoms have coincided Avith
external suppurations, the abscesses found in the lunps
after death are evidently of recent formation. I have
seen several such cases, in which, even though the final
catastrophe be attributed to the pulmonary complica-
tion, yet it is imquestionable that pyaemia must have
been prior to it. In these cases it is impossible to avoid
belief in the direct action upon the blood of the ele-

ments of pus derived from the surface of the original
wound.

The prophylaxis of septicfemia is more easily attained
than that of pyaemia, because the conditions upon which
septic poisoning depends are less peculiar than those
of pyaemia. There is no special anatomical condition of
tlie wound, such as exists when bony tissues are in-
volved. The system is capable of tolerating the ab-
sorption of a certain amount of septic material, and
Avhen, from the extent of the traumatism, there is an
excess of dead tissue, this may be removed by surgical
interference. The great indications in the prophylaxis
of septicaemia are 1st, to prevent the devitalization of
new tissues ; 2d, to prevent the exposure of tissues
thus devitalized to the action of infusoria, or animal
germs, the agents of putrefaction.

The first indication is pre-eminently fulfilled by
purification of the air which the patient is compelled to
breathe. This is effectual, not on account of any
direct action upon the wound, but by maintaining the
nutritive powers of the blood and its consequent action
upon tissues whose vitality is threatened. So long as
this vitality is maintained, the development of micro-
zymes is to be little dreaded.

The second condition is only completely fulfilled
when air is completely excluded from the wound, and
with it, on the one hand atmospheric germs, on the
otherthe oxygen necessary to the development of animal
microzymes. Air is nearly excluded when a wound
is enveloped in an atmosphere of carbolic acid, and to
such exclusion, must be largely attributed the favorable
result of such treatment. Occlusion, either by this so-
called " antiseptic " or by mechanical means, may pre-
vent the decomposition of traumatic fluids ; but when
this has once set in, nothing will arrests it, not even the
destruction of the germs which may have been its
cause, as we have seen, these die of themselves in the
putrefying fluids whose putrefaction they have deter-
mined. Hence a treatment directed to their destruc-
tion would be worse than superfluous, if it led to neg-
lect of the great indication in the prophylaxis of this
stage, removal of the traumatic fluids from beyond the
reach of absorbents.

The greater facility with which this removal may be
effected in the case of wounds of soft tissues explains
their greater immunity from danger, and the for greater
success of carbolic acid in their treatment. The septicaj-
mia that may occur in the course of such wounds, de-
pends upon the absorption of non-purulent decompos-
ing fluids, and its intensity is in proi)ortion to their
mass. When the fluids .-dready formed have been care-
fully washed away, the use of carbolic acid, that
will not, by the ordinarj' methods, ^»-ei'e?i< decomposi-
tion, nevertheless restrain it, and hence reduce septicae-
raic accidents to a degree of intensity bearable by the
economy. It is in these cases that the efiect of good
atmo?pheric hygiene is so apparent, by preventing the
devitalization of new tissues. The most dangerous de-
grees of septicaemia may be averted, and its worst form,
hospital gangrene, be entirely banished from hospital
waids.

But pyaemia is connected with much more comphca-
tcd conditions, many of Avhich are entirely beyond the
reach of carbolic acid. It depends on the presence of
a fluid that, once secreted, decomposes with peculiar
facility, seems to generate a poison of peculiar intensity,
and expose the products of its decomposition to ab-
sorption at a moment that the power of absorption is
at its maximum. It has been shown to act, not mere-
ly in virtue of such decomposition, like all putrid fluids,
but by a special effect on the blood, and by a special
connection with the thrombi blocking up the veins

THE MEDICAL RECORD.

surroiimliiig the wound. Whi'c the poison of sep-
ticaemia is jjiiiieipally absorbed by tlie lymphatics,
that of pyicmia passes almost exclusively by the veins,
cither those in the bones, or those newly developed in
the pranulalions of the wound.

Tiiis poison is therefore contained in inaccessible
canals, and carbolic acid lias as little effect upon it as it
would upon an aljscess in whose cavity it had been in-
jected and shut up to mix with its contents. A compa-
ratively minute proportion of purulent poison is capa-
ble of inllieting all tlie injury possible, so that great di-
minution of the ma5s of toxic material has very much
less elTect on the development of pyiemia than on that
of septicjcmia. The control must be complete, or it is
useless, and it nmst be exerc'sed not merely" in the
general hygienic conditions to which the patient is
submitted, but still more, over the local conditions pecu-
liar to the anatomical nature of his wounds.

From this i)redominanee of local conditions, pj'os-
mia is, as might be expected, no exclusively hospital
disea'^e. IJillroth asserts that it is as common in
private practice as in hospitals, only when a death
occurs that cannot be explained by hospital miasms, it
is attributed to gastritis, or other accidental complica-
tion. Mr. Callender, in the fifth volume of St. Bar-
tholomew's Hospital Reports, shows tiiat although the
mortality of city patients operated on in city hospitals
was higher than that of the country, yet the mortality
of country patients was the same, whether they were
in large city hospitals, in small country hospitals, or
even in average country practice.

It follows that absolute exclusion of air from the
wound is much more important in the prophylaxis
of pyaemia than of septicaemia. The partial occlusion
effected by incrustation with carbolic acid, is often
sufficient for wounds of soft tissues. But for wounds
involving osseous tissues, the apparatus employed by
M. Maisonneuve at the Hotel-Dieu is much better
adapted. Most American surgeons visiting Pai'is have
had an opportunity of observing this method of treat-
ment, but 1 do not know whether it has been intro-
duced into this country. The moment that a limb is
amputated, the stump is surrounded by a conical gutta-
percha cap, whose rim fits air-tight to the skin. From
the apex of this cap passes an India-rubber tube that
connects with an aspirating pump. B}' means of the
pump the liquids from the wound may be drawn off,
and discharged by a second tube into a receiver. Dur-
ing the intervals, the elastic walls of the cap and
tube coming from the wound, fall together so that no
air is in contact with the suppurating surface. To
dress the wound, the tube is detached from the pump,
and connected with the tube of a bulb-syringe, in
whose continuity is inserted a short piece of glass tub-
ing, so that the operator may watch the stream of fluid
he injects upon the stump, and be sure that no bubbles
of air pass over. The detersive licpiids employed are
either tincture of arnica or a solution of carbolic acid.
These, injected in a continuous stream on the stump,
are allowed to flow off by a secondary tube, connected
with that of the bulb-syringe. In this way the wound
is dressed daily, without the least exposure to the air.
The apparatus may also be used in cases of accidental
traumatism, as compound fracture ; but here it may be
less efficacious, when the dead tissues have already
been for some time exposed to the air.

As fir as my own observation extended, this appa-
ratus yielded excellent results, and the principle upon
which it is based seems certainl}^ most rational. I am
unable to tell why it is not adopted in other surgical
wards than those of M. Maisonneuve.*

* I found. aftPT writing the above, an account of Maisonneuve's appa-
ratus in the fifth volume of the PractUionei\

FORCIBLE MANUAL DELIVERY IN PU-
ERPERAL CONVULSIONS.

By JOHN M. JULIAN, M.D ,

The small number of reported ca,sesof manual version
in puerperal convulsions prompts me to offer a contri-
bution to the subject, with a view of calling the atten-
tion of the profession to an efficient means of saving
the life of mother and child, which means have not
received the attention which, in my opinion, they de-
serve. This is more particularly the case since anes-
thetics have been found to be so uscfid in the manage-
ment of the various complications of labor.

I was fu-st led to favor forcible manual delivery by
hearing of the death in convulsions of a primipara un-
delivered, aged 19, eight months advanced, whom I
had visited incidentally. In that, case I learned that
thij persistent administration of chloroform had uo
result whatsoever.

After having seen this ca;e, I determined to try, in a
similar case, the effect of Ibrciblc delivery. An oppor-
tunity for so doing soon presented itself On the
9th of June, 18C4, I was called to see Mary M., set.
21. She was six and a half months pregnant, had been
eight hours in convulsions, was ura;mic, had stertorous
breathing, pulse rapid and feeble, pupils insensible to
light, and the os barely admitting the end of the index.
With much less difficulty than I had previously antici-
pated, my hand was introduced into the vagina, next
the index, and subsequently, one by one, all the other
fingers were forced through the os ; next the hand was
passed in the uterus; one knee was hooked and brought
down ; find the delivery of a male child accomplished,
in the course of about tw-enty minutes. The convul-
sions did not return after delivery ; but she never
rallied, and expired the next day.

Case II. Reached Mrs. S.'s bedside September 8th,
1S64 (town of Guttenberg), a;t. 3G, primipara, whowa.s
in labor, had frightful oedema of body, was insensible,
and had stertorous breathing. Had been fifteen hours
in convulsions ; os admitting the end of the index finger.
I administered chloroform at once, and thereby con-
trolled convulsions, so as to enable me to deliver a pair
of male twins, the first, by version, being still-born ;
the other, by pedal extraction ; alive. There was one
slight convulsion three hours after delivery. Con-
sciousness returned the next morning, the albumen
disa[ipeared at the end of the sixth day, and mother and
child made a rapid recovery.

Case IlL Saw Mrs. S., set. 23, in consultation,
Nov. 21, 1SG5 ; primipara. with the usual uraemic symp-
toms ; had been fourteen and one-half hours in con-
vulsions ; insensible and stertorous since first attacked ;
OS undilated, no apparent symptoms of labor present ;
digital and manual dilatation and version performed in
less than thiity minutes, (with sanction of her medical
attendants), in the usual way, under chloroform. One
slight convulsion three hours after delivery ; she re-
mained insensible and afterwards delirious for over
fortj'-eight hours, from which she recovered; but
succumbed, one month from date of delivery, to an
attack of pleuro-pneumonia. Child ever after subject to
occasional epileptic convulsion, who died two years
after, of cerebral disease.

Case IV. Saw, in consultation, on the first of March,
1866, at 11 A.M., Mrs M. Stage of pregnane}', eight
and one-half months, primipara, urine two-thirds
albuminous, countenance antemic, fixed pain in fore-
head, nausea, pulse rapid and feeble. Counselled in-
duction of labor. At 5 p.m. a convulsion occurred. At

THE MEDICAL RECORD.

9^ P.M., with the concurrence of her medical attendant,
she being fully conscious and about the room at the
time, OS closed, was placed in the recumbent posture,
and fully aniusthetized. I inserted my hand as before
(encountering' this time a little more rigidity than usual),
and delivered twins — the first child by version. Both
children lived. The mother made a rapid and uninter-
rupted recovery, tlic operation occupying about half
an hour's time.

Case V. Saw, on August 4, same year, a next-door
neighbor to !Mrs. M., Mrs. W. Stage of pregnancy
said to be eight months. Had been about ten hours
in convulsions ; primipara, urtemic, deep stertor, pulse
rapid and feeble, circulation apparently ceasing. Had
been previously to my coming ineffectually anjesthetized
during several hours ; os undilated. I proceeded at once
to deliver in the usual way, which Avas soon accom-
plished, this time without anaesthesia. The convul-
sions ceased after delivery, but she expired the next
day.

Case VI. Mrs. J., a?t. 22, secundipara, who, during her
previous pregnancy (sixteen months from date), had
suffered from uraiinic convulsions, ending, five or six
weeks after their occurrence, by the spontaneous expul-
sion of a decomposed foetus; whole growth appeared to
be of about five months. I was requested to see her
on the 5th of March, 1869, at 4 a.m.; said to be in her
seventh month ; face and lower extremities oedematous ;
headache, nausea, pulse about 54 ; had had two con-
vulsions previous to my coming; medical attendant
gone home 12^ p.m. ; return of convulsions and vomiting,
pulse 40 ; insensible, os closed, no symptom of labor.
I at once proceeded to perform version under chloro-
form, and in the usual and above-described way, which
was accomplished in about twenty minutes ; child a
male one, non-viable. The convulsions never returned,
consciousness became gradually restored, and she
made a rapid recovery. On the 6th of June, 1871, she
was again spontaneously delivered at eight months of
another male child, but this time without; convulsions ;
child died on the twelfth day, of epileptic convulsions;
albumen Avas again detected in Mrs. J.'s urine.

In conclusion, I will state that my object in publish-
ing the above has been to induce others to give the re-
sult of their experience in this matter, and help to
establish, by a sufficient number of precedents, the
propriety or impropriety of the operation. Inas-
much as a great number of obstetrical authorities look
upon the measure as a most desirable one if it can be
accomplished without injury or detriment to the pa-
tient, I think that on this point the general result of
my cases ought to have a tendency to dispose of this
objection, and demonstrate that the operation can
a priori be performed with tolerable safety and celer-
it}'. They also suggest the belief that, under full an-
aesthesia, the question of non-dilatability of the os has
not been as yet properly or sufficiently looked into ;
and that, at least in special cise^, this operation
ought to take precedence over the safer but more tardy
rule of induction.

Theref ire, I feel most sanguine in the belief, that
should this mode of procedure be more generally fol-
lowed, in like emergency, the mortality tables of puer-
peral convulsions would become notablv improved,
and the lives of fewer women and children sac-
rificed.

In corroboration of the preceding remarks, I beg to
observe that, in a very extensive search made into the
. literature of the subject on manual dilatation in puer-
P-^ral eclampsia, I have found but five cases, which,
however, fuily substantiate m}'' views : one of these
will be found by Nocggerath and Jacobi, another by Dr. ''

Paget, one by Dr. J. H. Ross, and two by Dr. Holland,
copied from the Lancet, and found in Braithwaite's Re-
trospect, Vol. Ixiv., the results of all of which were
successful, and one equally successful in Milne.

I will further observe that the large sanguineous de-
pletion deemed indispensable, and so firmly relied on,
is fiilling into disfavor. In the Guy's Hospital Re-
ports for 1871 will be found a scries of cases, by Dr.
Phihps, in which bleeding was not resorted to, and
chloroform mainly relied upon for the control of con-
vulsions ; a practice which has likewise been followed,
in the latter part of his life, by our late distinguished
fellow-to\vn=man. Prof Geo. T. Elliot.

273 West 21st st., New York.

procuress of iHetJical Science.

The Blood in Syphilis. — Dr. Lostofer's alleged dis-
covery of bodies peculiar to syphilitic blood, has led
to considerable discussion in Vienna, the most promi-
nent of his opponents being Dr. Wedl, who claims that
they are only oily particles obtained from the sebaceous
follicles in the operation of puncturing the skin. The
bodies under question are described as having a diame-
ter ranging from jii^nr to T^riuir of an inch, their con-
tour being sharply defined, and light being strongly re-
fracted by them. They are said to have a greenish-
blue tinge. With regard to the vacuoles with which
these corpuscles are said to become surrounded, Dr.
Wedl believed them to be the result of a destructive
process, being induced by the development of water and
of carbonate of ammonia during decomposition of the
blood, the same phenomenon being observable when
an emulsion of human fat is heated with a solution
of potash. The reason why Dr. Lostofer had seen
these corpuscles only in blood after four or five days,
and not in fresh blood, was that they were covered by
the blood corpuscles.

Professor Strieker said he had placed a hundred
specimens before Dr. Lostofer who had diagnosticated
correctly those taken from syphilitic patients, with the
exception of twenty doubtful eases. He did not
venture to assert that they were either germs or
fungi.

Dr. Neumann said that nearly four years ago Hallier
described the structures found in the blood in infectious
diseases, including syphilis; he said these gave rise to
syphilis, and their most minute elements penetrated
the blood corpuscles and rendered them diseased. The^e
corpuscles multiplied by division, assuming the charac-
ters o{ coniothecium. Hallier had found them in syphi-
litic paronychia, condylomata, and in other manifesta-
tions of syphilis. Oklotsch had also found traces of
them in the skin as well as in the blood. The result
of experiments which he had made Avith specimens of
blood from persons presenting various forms of syphi-
lis Avas, that bacteria Avere developed in the blood-cor-
puscles of the infected blood which differed in no re-
spects from those developed under similar circumstances
in the blood from other contagious diseases ; even after so
long a period as tive months these organisms multiplied
in their OAvn forms, and. in spite of the addition of the
A'arious organic and inorganic substances, no fungi
Avere found. Since Dr. Lostofer had announced his dis-
covery, he (Dr. Keumann) had made fresh investiga-
tions, and had found that the corpuscles might be de-
A'eloped in various numbers and sizes in different kinds
of blood. He had found them in the blood of small-pox,
eczema, etc.; and therefoie they could not be regarded
as a specific indication of syphilis.

. THE MEDICAL RECORD.

The discussion tcnnina'cd with the aiipuintiiioiit of
a comiiiitti'C to invcsiij,'ale the suhjict, c'oii8istiii<,' of
Dr.". K(>kitnii*i<y, Hnicke, Billrotli, keiclifit, Karsicn,
KI<>1>, liausch, ;ur1 Aiispitz. Dr. Kraus, cdiior of the
Alg. Wiener Med. Zeil., m of the opinion thai Dr .Striek-
er, IIol>ra, and others have been deci-ivid, and have
acted nio^t unwi.-ely in furmin;.' their opinions so rapid-
ly. Sk(;da i^ecnis also to have been very precipitate.

Protr.\ctkd Gk.«tation with PuEnrEnAi, Convi'l-
Pioxs. — K. P. Bernanl}', Philailelpiiia {I'liVa. Med.
Times), relates a case of protracted <::estjitiun, in aprinii-
para, in which the child was carried, he believes, three
liundrcd and forty-four days. During tliirty-three
convulsions, extending over a space of eight hours,
eleven .><crup!es (220 grains) wore given, wliiih only
seemed to cpiiet her. There was no deep sleep, the
)iaiient being easily wakened. Tliis is interesting as
showing how mucli hydrate of chloral can be given in
convulsions without any bad eflect.

The eliild was enormous, weighing fifteen pounds,
and, when drcssel. appeared as if it were three months
old instead of a few hours. The proportions of the
head were as follows: circumference, 15 inches; occipito-
mental diameter, 8 inches; fronto-mental, 4+ inches;
occipito-frontal, GJ inches; length of the body, 2G|
inches; weight of the body, 15 lbs.

Uterine Anomaly. — Dr. Hening, at a late session
of the Leipsic Obstetrical Society {/own. Gynceco-
logical Sue), reported in brief a case of uterine
anomaly in a girl fourteen years old, in which, in-
stead of the uterus, there was a shallow pocket two
centimetres deep.

Microscopical Exa.mination of the Sputi'm. — Dr. A.
P. Dutcher, Cleveland, Ohio (Cinn. Med. A'eif.s), adds
his testimony as to the value of a microscopical exami-
nation of the sputum as a means of diagnosis in chest
diseases. Dr. Huglies Bennett concurs w'ith Dr. T.
Thompson in recommending it as a very useful means
of diagnosis in all doubtful cases of phthisis. Dr. An-
drew Clark, of London, regards the examination of the
sputum as the only certain means of detecting the dis-
integration of the lungs and the increase of the disease.

Chronic Cystitis in the Female, and Treatment. —
In an interesting paper on this subject by Tliomas Ad-
dis Emmet, M.D., Surg, to K Y. State Woman's Hos-
pital (Am. Practitioner), describing a mode of treatment
original with him, with cases, allusion is made to the
paper on " Tlrcthrocele, Catarih, and Ulceration of the
Bladder in Females," which was published in the X. Y.
Journal of Obstetrics, Feb., 1S71. Dr. Bozeman is
quoted as stating that the operation for the relief of
cystitis by an artificial opening was performed by him
January, 1801, and that ''to Prof. Wiliard Parker is
due'the suggestion of opening the male bladder for the
relief of catarrh, and this encouraged me to extend the
practice to the female bladder," and that "Dr. Emmet
and other American surgeons have since adopted the
practice in case of vesical catarrh in the female, and I
doubt not with equal success," and that the "' delay in
the report of my case of ulceratioti was due to the sus-
pension of all medical journals in the South during the
war."

Dr. Emmet says that this statement is unfortunately
calculated to give the impression that the American sur-
geons who have practised this mode of treatment since
1861 were indebted to Dr. Bozeman. This is errone-
ous, as until his paper was r-ad at the meeting of the
New York State Medical Society, Feb. 7th, 1871, he
(Dr. B.) had not given the profession an opportunity
of knowing that he had ever operated.

Dr. Emmet's claims to priority extend back to the
year 1858, when, by the advice of Dr. Sims, after the
removal of a calculus from tlic V^ladder by an artificial
opening made in the vesico-vaginal septum, the aper-
ture was left open for restoring the organ to a healthy
state. In 18G1, for the relief of a case of chronic cys-
titi.s, an artificial vesico-vaginal fistula was made by
him, with the view of giving rest to the organ bv the
free esca|ie of urine.

The history of a case, upon which he had just operated
by making an incision transverse to the axis of the vagina,
was read at a meeting of the N. Y. Obstetrical Society
in Dec, 1870. Prof. James P. White, of BiifTalo, an
invited guest on that evening, reminded the author that
he a.ssisted at the operation in ISGl, and, by a curious
coincidence, was present at the final closure.

Detection of Hydrochloric Acid in Cases of Sus-
pected Poisoning. — J. Bonis (Journ. nf Applied C'liem-
istri/) filters the liquid through linen and paper
previously moistened with acetic acid, and introduces a
few crystals of chlorate of potash and some gold foil.
The whole is then heated over a water-bath an hour or
more, and the presence of the free acid determined
from the quantity of gold that goes into solution.
Chloride of tin at once betrays the faintest trace of any
gold that may have been dissolved. If the liquids to
be tested are very dilute it is advisable to concentrate
by evaporation. The author was able to detect in this
way the presence of a few centigrammes of hydro-
chloric acid in a large quantity of liquid. He made
comparative examinations to prove that chlorides of
sodium, potassium and the like did not produce similar
reactions.

Antidote to Carbolic Acid. — A strong solution of
saccharate of lime, it is asserted, is a reliable antidote
against the poison of the carbolic acid when by acci-
dent taken internally.

A New Method of Plugging the Posterior Nares.
— Henry Manfred, M.D., Cincinnati, Ohio, late Surgeon
22d Ky. Infantr}' (Cin. Lancet and Observe)-), afier try-
ing all the ordinary remedies for epistaxis (the hospital
being without a plugging instrument), in the case of a
soldier who had suffered for four da3's and nights with-
out cessation, a pair of leather laces were successfully
used in the emergencj'. The leather thong was care-
fully pushed along the floor of the right anterior nares
until the end protruded through the posterior opening,
trailing upon the epiglottis and producing cough; this
loose end Avas secured by the forceps and drawn out
through the mouth, and after attaching thereto pledgets
of lint saturated with astringents, it was drawn back
again until the right posterior nares was effectually
plugged, and tied in front. The same process was re-
peated with the left posterior nares, and in half an hour
the hemorrhage was stopped. He fully succeeded in
plugging the right and left posterior nares, by such a
simple though efi'ective agent. From its simplicity, ef-
ectiveness, and practicability, it is to be recommended
to those who may be similail}' situated.

The Eye in Brigiit's Disease. — With regard to the
frequency of changes in the eye in Bright's disease, Dr.
Wadsworth, of Boston {Boston }[ed. and Surg. Journal),
stated that he had for some time past examined every
case that had been admitted into the City Ho.-pital, and
had found that in about 25 per cent, trouble in the eye
existed. Dr. Fifield said that the strange part of thtse
cases was the great and sudden variation in the state
of vision. In some cases vision would be very much af-
fected for a few days, and then would become almost
normal

THE MEDICAL RECORD.

The Medical Record:

A SEMI-MONTHLY JOURNAL OF MEDICINE
AND SURGERY.

GEORGE F. SHRADY, A.M., M.D., Editor.

Pxibliiihed on the 1st caul \^th of each Month hy
WM. W'OOD & €0., 27 Great Jones Street, N. Y.

ISTew York, .A^pril 1, ISTS.

MEDICAL COLLEGE COMMENCEMENTS.

The College Commencements are now over, and medi-
cal educational circles have a temporary rest. The
students have received their diplomas, the addresses
by professors and valedictoiians have all been duly
delivered, the various orchestras have done their part,
and now the medical sensation-hunters are left to their
sober reflections. When we compare the present
graduation exercises with what they were twenty
years ago, we are forced to acknowledge that great
changes have been made in the manner of conducting
them. When we were fortunate enough to receive our
medical diploma from the faculty of one of the three
medical schools of this city, we were treated to the
usual long and heavy address from one of the professors,
and the only element in the whole proceeding which
made it more than one of the dryest and most tedious
lectures of the term was the exhilarating presence of a
few of our female friends, who from motives of mere
pity consented to worry through the hour, and assure
us afterwards, in a purely feminine sense however,
that they were gratified. Every graduate enjoyed these
occasions because it was to be the last straw that
could in the way of a lecture be pliced upon the back
of liis memory. No one looked for arjy thing more, save
perhaps the questionable propriety of promenading
his friends through the college museum to guess at
the character of half of the specimens so conspicuously
covered. It was considered " derogatory to the dignity
of the profession " to court anything in the shape of the
ordinary means of amusement on such occasions, and a
band of music was thought to be as much out of place
as it Avould have been in an old -timed Puritan prayer-
meeting. But we have lived to see all this changed,
and we can say, that so far as the introduction of good
music and the other accessories of an enjo3'able enter-
tainment are concerned, the innovation has been a very

commendable one. There are, however, changes to be
made for the better in the accessories, and by these we
refer to the addresses. Occasionally we are treated to
first class cflbrts in that direction, but in the main,
when left to the faculty, they are to the Inst degree
commonplace and tedious : commonphice. if the aim is
to interest a promiscuous audience; and tedious, if
treating upon a i:>urely scientific subject. Every one
who takes the trouble to go to a College Commence-
ment is willing to admit that medicine is a noble pro-
fession, in fact the noblest of all professions, that, the
graduating class have shown a lemarkable proficiency
in their studies to gain a d'ploma from a faculty so
jealous of the interests of medical education, and that,
all told, the said college must be the best in the countiy.
Every one is willing to admit, for the sake of the argu-
ment, that it is up-hill work to succeed in the practice
of medicine — that even those brilliant young men who
with demure looks and bowed heads are receiving the
professorial blessing are not exempt from the applica-
tion of the saying that " there is no royal road to
knowledge;" all this is a very old story, and if it is to
be told, after the stereotyped flishion, witli the worn-
out anecdotes from Smiles' Self-Help, and Jeaffreson's
Bijoh ahout Doctors J becomes almost unbearable. Now,
why can we not keep up the new fashion of inviting
some practised and entertaining speaker to interest our
commencement audiences ? This has been tried with
good effect on more than one occasion, and we see no
i-ea.-on why this practice cannot be kept up.

The addresses of the valedictorians are well enough
in their way. They give a variety to the entertain-
ment, and, in return, the audience is generally good-na-
tured enough to submit to the habitual sophomorical
display of oratory. The only improvement that could
be suggested in these addresses, would be to have
them as brief as would be consistent with the gratifi-
cation of the speaker.

I3ut there is one aspect of this subject which in this
connection deserves a passing reference. The changes
that have been wrought in our college exercises have
had the eflcct, at least, of drawing large audiences,
as large perhaps as usually attend the literary schools
on such occasions. This has an unquestionably good
influence upon the general pubhc in impressing
them with the fact that there is an enthusiasm in
the cause of medical education, and that our medi-
cal institutions are progressive and prospering. Each
institution has the opportunity of maintaining a gen-
erous rivalry in this respect, and if limited by the
rules of ordinary propriety, we have reason to
expect that the jealously-guarded dignity of the pro-
fession Avill not suffer. But that there is danger
of carrying the competition a little too far is pain-
fully manifest in more than the mere commencement
exercises. The colleges, stimulated by their respective
successes, are promising to become the centres of un-
compromising cliques. Already with some fanatical in-

THE MEDICAL RECORD.

diviJunls tlie fi't'ling of competilion is fostered to that
extent tliat hardly the actual courtesies arc alloweil be-
tweon the parties of the diflerent schools. In the in-
teresLs of the general profession of this city we arc sor-
ry to entertain tlie suspicion of inij)eiiding discords.
We rejoice in the pro.><perity of the schools at large;
we should be glad to see the spirit of legitimate emu-
lation carried to the extent of raising the standard of
requirement'? still more, but beyond this we do not ex-
pect to go. We claim that each school has the privi-
lege of rejoicing over its successes, but neither must
allow it*; ambition to get the better of its judg-
ment. Not committed to the interests of any school,
and alone concerned in their collective prosperity, we
maintain that the rivalry should be just, honest, and
courteous. That it is not so, and that there is on
that account great danger of fostering cliquism, we
shall on some future occasion take the opportunity of
proving.

A.MEnicAX Mkdical Association.

We learn that great efforts are being made by the phy-
sicians of Philadelphia to receive the American Medical
Association with dignity and to entertain them court-
eously. As soon as the entire programme shall have
been decided upon, we Avill be furnished with the
details of the arrangements, and can then announce to
our readers the character of the scientific and social
entertainments which will be tendered to them. We
understand that New York will be ably represented
in the programme.

Hcuicius anti lloticeg of l3ooK0.

A TuEATisE OX Human Piitsiology, Designed for
THE Use of Students and Practitioners op Medi-
cine. By John C. Dai.ton, M.D., Professor of Physi-
ology and Hygiene in the Collec^e of Physicians and
Surgeons, etc., etc. Fifth edition. Philadelphia:
Henry C. Lea, 1871. pp. 728.

Tnis well-known book comes to us again with an in-
crea_se in size of twentj^-three pages over the edition of
18G7, which does not, however, represent quite all of
the new matter, as some of tlie contents of former edi-
tions has been left, out. The most important changes
have been made in the chapters on the formation of
sugar in the liver, coagulation of the blood, the arterial I
circulation, the excretion of urea, and terminations of
the nerves. The most valuable of the several wood- '
cuts introduced for the first time into this edition are I
in this latter section. j

The author states that, recognizing the recent acti-
vity in the advance of all the natui'al sciences, he has j
carefully revised the entire work. We have looked
through its pa^es to see how far this prefatory announce-
ment is justified by the changes and additions made,
and whether "the book in its present form" is, as he
has aimed to render it, "a foithful exponent of the actual
condiiion of [diysiological science."

In the section on proximate principles, the introduc-
tion of Fehling's test for sugar was a needed addition.

In his estimate of the amounts of fibrin and albumen

contained in the blood, the author is not consistent.
Under tiie head of proximate principles in general, he
says, " It is to be kept constantly in view, in the exami-
nation of an animal tissue orlluid, that tlu; object of the
operation is simply tite separation of its ini/rrdicnts from
each othn; and not their decomposition or idlimate
analysis. . . Thus, tlie fibrin of the blood can be sep-
arated only by allowing it to coagulate; and once co-
agulated, it is permanently altered, and can no longer
present its original characters of fluidity, etc., as it ex-
isted beforehand in the blood. In such instances as
this, wo can only make allowance for an unavoidable
difficulty, and be careful that the substance Ruffers no
further alteration." Yet in his estimates ho follows
the "dry process," and gives the amount of fibrin as 2
or o parts per thousand, and that of albumen as about
75 parts j)L'r thousand. The process, of which he makes
no mention, in which they are separated simply by co-
agulation, gives about three times as much librin, and
more than four times as much albumen.

No essential changes have been made in the section
devoted to the subject of digestion, and we take the
liberty of asking atti-ntion to one or two points. With
regard to the action of saliva in converting starch
into dextrin and glucose, the author continues to
maintain the views advocated in the early editions of
his work, although the fallacy of the experiments upon
which some of his statements were based was pointed
out several years since. The action of saliva ni)on the
food is, he says, simply mechanical ; and although, in
experiments made with human saliva upon boiled starch,
the mixture has sometimes shown the presence of glu-
cose at the end of half a minute, yet this property of
the saliva is, he thinks, rather an incidental than an es-
sential one, the food remaining for too brief a period
in the mouth for the transformativm to take place in
any great degree, and the process being at once arrested
by the action of the gastric juice on the anival of the
food in the stomach. Two important facts aie lost
sight of in the experiments cited in support of these
views: first, in carnivora (dogs having been the animals
operated on) the saliva has but a very feeble action on
starchy food ; second, some of the principle? contained
in the gastric juice have the property of interfering with
tests for glucose. Experiments reported by Longet
eleven years ago seem to prove pretty conclusively the
power of saliva to produce this change, in the human
subject, during stomach digestion.

Dr. Dalton diflers from most modern writers in his
description of the tubular glands of the stomach, and
also in his opinion that all the gastric tubules in the
various parts of the stomach combine to produce the
digestive tluid. We think there are few physiologists
wlao do not consider that the fluid which is most active
in stomach digestion is secreted by tubules containing
glandular or spheroidal epithelium, situated most nu-
merously towards the cardiac extremity of the organ;,
the tubules met with in greatest frequency at the py-
loric extremity being lined with columnar epithelium^
and secreting mucus chiefly.

There is a subject of some interest connected witl
the function of digestion which we would have beeni
pleased to see at least nientioned, viz., the ability of the]
large intestine to digest and absorb sufficient nourish-
ment, in some instances, to maintain life.

We are not a little surprised at the views expressed]
with regard to the course taken by the oleaginous]
principles of the food in reaching the circulation.'
"The absorption of the digested fluids is accomplished |
mainly by the blood-ve?seis. . . . The fatty matters of]
the food," he says, after speaking of albuminoids,
etc., " are also taken up by the blood-ves?els and pass in

THE MEDICAL EECORD.

this way into tlie circulation. . . . The oleaginous ma-
teiials, thus prepared, are absorbed by the blood-vessels
of the intestine. . . . The oily matter then pnsses on-
wards, penetrating deeper and deeper into the sub-
stance of the villus, until it is at last received by the
capillary vessels in its interior." The only reference
made in this connection to the function of the lymphat-
ics, is this, something over two pages having been
devotL^d to explaining the modus operandi of the passage
of, fat into the portal system : " The absorption of fatty
matter is also accomplished by another set of capillary
vessels of the intestine, namely, the ' lacteals.' " We
are atalossto know'on what grounds Professor Dalton
attributes »the function of absorbing tlie greater part
of the chyle to the blood-vessels. We are aware that
in birds this is the case ; but in the human subject, we
had thought it pretty definitely settled by post-mortem
appearances, by the effects of disease of the mesenteric
glands in producing emaciation from obstruction, of the
passage of chyle, and by experiments upon animals
approaching nearest to man in the arrangement of the
digestive apparatus — that, although some of the fatty
matters may be absorbed by the blood-vessels, yet, far
the greatest amount enters the circulaiion through the
lymphatic ."iystem. We question very much if the
author has, in this regard, made his book " a faithful ex-
ponent of the actual condition of physiological science."

Speaking of the modes of origin of the lymphatics he
says they "are to be found everywhere in the integu-
ments of the head, the parietes of the trunk, the upper
and lower extremities, and in the muscular tissues and
mucous membranes throughout the body," omitting two
of the most important tissues, viz.. the connective tissues
and the serous membranes, and therefore any mention
of their frequent origin in lacunar spaces between organs.
Indeed, by many histologists it is now considered as
settled that the serous sacs are integral parts of the lym-
phatic system.

In speaking of the function of the bile, the author,
although at the outset his words would lead the stu-
dent to infer that this fluid contains excrementitious as
well as recrementitious principles, makes no mention
of the excrementitious principles. After giving some
of the reasons why we might, suppose the fluid to be
excrementitious, he proceeds to show that the death of
an animal in which a biliary fistula has been success-
fully established is owing to the fact that the principles
of the bile are not brought in contact with the se-
cretions of the intestinal canal, and with the intestinal
walls; and lie goes on to state that the bile " is a se-
cieiion which has not yet accomplished its function
when it is discharged from (he liver and poured into
the intestine," and that all of the biliary ingredients are
absorbed, and are not to be discovered in the fseces.
Not a v/ord is said of cholesterin, and the student will
probably end the chapter with the idea that his first
impression, that the liver had an excretory function,
was a mistake.

A considerable addition has been made to the chap-
ter on the formation of sugar in the liver, bringing it
quite up to our present knowledge of this function.
And here we must compliment the professor's well-
known powers of description, for, with the aid cf two
wood-cuts and a few lines of text, we have not the least
difficulty in recognizing his "comminuting machine'^ as
the article so familiar to most eyes as a "fluting ma-
chine." To those who have, (or the last five years, been
familiar with the researches of Chrzonszczewsky and
others on the origin of the bile ducts, as verified by Dr.
Stiles of Brooklyn, {Third Annual Report of the Metro-
politan Board of Health, 1868, p. 256-57) the coolness of
the following quotation, from page 245, will be refresh-

ing : " The exact mode in which these cells arc connected
with the hepatic duct was for a long time the most ob-
scure point in the minute anatomy of the liver. It has
now been ascertained, however, by the researches of
Dr. Leidy, of Philadelphia, and Dr. Beale, of London,
that they are really contained in the interior of secret-
ing tubules, which pass off from the smaller hepatic
ducts, and penetrate everywhere the substance of the
lobules. The cells fifl nearly or completely the whole
cavity of the tubules, and the tubules themselves lie in
close proximity with each other, so as to leave no
space between them except that which is occupied by
the capillary blood-vessels of the lobular plexus."

The student, searching for information as to what is
meant by the amoeboid movements of the white blood
corpuscle, will fail to obtain, from the volume under
consideration, an}'- intimation th;it this body is any-
thing else than "globular in form" under all its normal
conditions. It is also apropos to remaik that the ex-
istence of this same white corpuscle outside the walls
of the blood-vessels is not even hinted at in the shape of
allusions to the existence of lymph, sahvary, or mucous
corpuscles. In writing of the milk, colostrum corpuscles
are mentioned, but nothing is said of the fact that they
are identical with the so-called white corpuscle. No
mention is made of the leucocyte in the article on the
spleen, the minute anatomy of which consumes two
pages, and the effects of its retnoval from the lower
animals another. Not a word is said anywhere about
the minute anatomy of the kidneys or the effects
upon animals or man of their removal, by operation or
disease, save in an aflusion to the effects of suppression
of all of the excretions. On page 355 he says, " The
kidneys, on the contrary, do not secrete anything,
properly speaking, and are not, therefore, glands."
What they are, he does not inform us.

In the preface, the author says: "And accordingly
the discussion of doubtful and theoretical questions has
been avoided, as a general rule, in the present volume,
while new facts, from whatever source, if fully estab-
lished, have been added and incorporated with the
results of previous investigations." It would have been
interesting to students of physiology throughout the
scientific world, if Professor Dalton had made an ex-
ception to his general rule, and told them how he came
by the decision of a question, which has for years been
one of the most difficult problems they have had to
solve, viz., the cause of the coagulation of fibiin, or on
the other hand the cause of its remaining fluid. Robin
and Verdeil abandoned the subject. Avith the assertion
that it is "as vain to seek after the cause of this fact as
to inquire why fibrin exists, why sulphate of copper is
blue," etc. Professor D. has at length solved the prob-
lem. "The answer to this que?tion," he says, " is as
follows :— The fibrin remains fluid during the natural
state of the circulation, because, like the other ingredi-
ents of the blood, it is constantly undergoing clianges
wdiich prevent its arriving at the state necessary for co-
agulation." What the " states " are, to which the other
ingredients of the blood must arrive, in order that then
may coagulate, we all know of course — the chloride of
sodium for example. " We can easily understand how
tills should be the case," he continues, " when avc re-
member, in the first place, the extreme rapidity with
which the blood moves in the vessels of the living
body. . . '. Secondly, the fibrin of the blood dis-
appears while passing through the liver and the hidneijs.
. . . . By calculating approximatively the quan-
tity of blood contained in the whole body and that
passing daily through the liver and kidneys, it is
easy to estimate that a quantity of fibrin equal
to 'that in the entire blood is destroyed and re-

THE MEDICAL RECORD.

produced sevornl times over in the course of a single
day. Thus the fibrin existing in the hlood at any one
timo, is tliat which has been recently foniicd ; and be-
lori' the time arrives at whieli it wouM naturally coag-
ulate, while still in the vessels, it. has already been
decouiposeil by its usu d metamorphosis in the circula-
tion, and has l)eon replaced by a new supply of still
more recent formation." Now not all of the fibrin in
the body is coutaiued in the blood-vessels, but a very
considerable proportion is to be found in the lymph,
which moves in the largo vessels at a speed no greater
tiian an inch in a second, and very much more slowly
the nearer we anproach the periphery. Again, the fluids
wliich we find in the serous and synovial cavities are
known to contain, sometimes, fibrin in considerable
amount; and tliese fluid-', under certain circumstances,
undergo little or no movement, so far as can be demon-
strated : surely they are not passed through the liver
an<l kidneys at short intervals in order to undergo their
"constitutional." IJow, then, is the fact that they do
not coagulate while yet in the body to be accounted for?

We now come to the function of respiration, and
first arises the query how much influence is likely to
be exerted on the diffusion of air in the bronchia by
the movement? of so much of the cilia, (whose whole
length is but 4,,'irii to 7v,VTTof an inch) as projects beyond
the layer of mucus which covers the walls of these
canals.

The statement that the oxygen of the blood is present
in solution in the blood globules, instead of in combina-
tion with some of their elements, can hnrdlv be said to
agree with the results of experiments by Bernard and
others since 1859 ; nearly, if not quite, all of the writers
since that period agreeing that it is in the latter con-
dition. The quotation from Magnus, "'that the blood
holds in solution 2i times as much oxygen as pure
water could dissolve at the same temperature," is all
very well as far as it goes, since this is about the
amount held in solution by the plasma ; but as for the
whole quantity of oxygen the blood is capable of con-
taining, this statement gives only about one-tburth the
amount now accepted.

No mention whatever is made of the researches of
Dr. Hutchinson, of England, with reference to the
amount of air respired by an individual being a test of his
his vital capacity — observations which are of daily use
the examiner for life insurance.

We simply note in conclusion, for we have already,
we fear, transcended the bounds of the reader's for-
bearance by the length of our remarks, that the capil-
laries are spoken of as "simple, homogeneous, nucleated,
tubular membranes." It occurs to us, that a nucleated
membrane can hardly be called homogeneous ; and
we call to mind the photographs and engravings of the
epithelial cells forming these tubes, which, since Cohn-
heim's experiments on the wanderings of the leucocytes,
have become familiar to most of us.

Remarking, lurther, tliat none of the researches of late
years liave been added to the chapter on speciil senses,
we bring our liasry ;iud incomplete review to a close.

That we cannot give our indorsement to " the book,
in its present form," as '• a faithful exponent of the
acturd condition of nhysiological science," is, we suspect,
pretty evident. We say this with regret, for, if we ex-
cept English work-, there is not in this coimtry, at the
present day, a complete treatise on Human Physiology
available to the student and practitioner of medicine,
not encumbered by a great deal of matter in which
neither of these classes is particularly interested. It is
our belief, that it is only this fact, and the protective
tariff on foreign books, which have permitted the pub-
lication of this fifth and stereotyped edition.

DiAOUAMB OK THE NERVES OF THE HUMAN BODY,

exhibiting their origin, divisions and connections, with
their distril>ution to the various regions of the cu-
taneous surface, and to all the umscles. By WlLLlA.M
IlKMiY Fi-oWKU, F.R.C.S., Assistant Surgeon to, and
Demonstrator of Anatomy at, the Middlesex Hospital.
I'ilited, with addition.s, l)y WiM.AM W. Kkkn, M.D.,
Lecturer on Anatomy and Ojjorativc Surgery in the
Philadelphia School of Anatomy, etc., etc. Phila-
delphia: Turner Hamilton. 1872. 4to, pp. 11, with
full-page lithographic plates in two colors. Price,
$1.50.

We are glad to see these standard diagrams placed
within reach of American students and practitioners, in
a form more convenient for use tlian the English (folio)
edition, and at less than one-fourtii its expense. For
presenting clearly to the eye the salient points of what
is unquestionably to the average student the most diffi-
cult, and so the most neglected, part of de8cri|)tive
anatomy, they leave almost nothing to be desired.
Where improvement on the original seemed possible, it
has been made by Dr. Keen with the same clear, prac-
tical. judgment which we had to thank, a year or two
since, for the remodelling of Heath's Anatomy. That
book, with his additions and modifications, a teacher of
our acquaintance, who has given it two winters' trial
in the dissecting room, pronounces the best working
dissector in the English language.

A Text-Book of Pathological Histology ; an intro-
duction to the study of pathological anatomy. By Dr.
Edwaud RiNDFLEisrn, 0.0., Professor of Pathological
Anatomy in Bonn. Translated from the second German
edition, with permission of the author, by William C.
Kloman, M.D., assisted by F. I. Miles, M.D., Pro-
fessor of Anatomy, University of Maryland. Phila-
delphia: Lindsay it BlakLston. 1872.

Ax Ixtuoductiox to Pathology and Mokbid Ana-
tomy. By T. Henry Green, M.D.. London, Lecturer
upon Pathological and Morbid Anatomy at Charing
Cross Hospital Medical School. Philadelphia: Henry
C. Lea. 1871.

It may, we think, be asserted with truth that in no
department of practical medicine has such materinl prog-
ress been made of late years as in that of pathological
anatomy. This progress has been so thorough that it
has rendered the works published upon the subject ten
or fifteen years ago almost valueless, or, at any rate, has
rendered large portions of them utterly valueless, and
has caused a more or less complete modification of the
balance. It would seem that to Germany belongs the
credit of thoroughly and laboriously studying patho-
logy, and of bringing it to its present standard, and that
the German mind, which works slowly and carefully,
avoids theories and aims for truth, is specially adapted
to the task of studying pathology, which can only be
mastered by patient and long-continued observation.
Previous to the publication of the volumes the title of
which licad this article, pathological anatomy was in a
very complex and unsatisfactory state in this country,
and the same may be said of the state of our knowl-
edge of normal histology. As text-books upon patho-
logical anatomy we made use chiefly of those of Vogel,
Cragie, Jones, Sieveking, Wedl, and Wilks, all of
which were entirely too antiquated. Witli these ex-;
ceptions, and perhaps some portions of works upon the
practice of medicine, treating upon the subject, and the
occasional translation or resume of an article on patho-
logical anatomy in the journals, we were wdiolly desti-
tute of a work embracing the whole subject, and in this
connection we may add, that although Virchow's work
on Cellular Pathology treated of tiie subject, yet as it
was devoted to a theory and did not embrace the whole

THE MEDICAL RECORD.

subject, it failed of the purpose of a text-book. The
great cause of tliis want of a text-book upon patholog-
ical anatomy, we think, lies in the fact that as this
subject is not systematically taught in our schools, the
interest which it should exercise was wanting, and
hence the profession paid only slight attention to it. This
absence, in our curriculum of medical study, of thorough
means to convey instruction in pathological anatomy,
is one of our moat serious drawbacks. In days gone by
the absence of such instruction was unavoidable, as
there was in reality no one sufficiently accomplished in
ihe branch to constitute instructors in it; but now,
owing to the enormous facilities offered in G-erman
universities, many of our countrymen are fully able,
as evidenced by the publication of their own observa-
tions, to teach students of medicine this very essential
branch thoroughly. It is true that many of the details
of pathological anatomy are taught en courant in the
courses on surgery and on the practice of medicine ; but
pathological anatomy is a subject which certainly can-
not be imparted by viva voce teaching, and can only be
thoroughly mastered in the laboratory under com-
petent instructors. Of late years the numerous able and
important monographs upon pathological anatomy
which have been published in the German medical
journals, particularly Virchow's Archiv, have greatly
interested the thinking portion of the profession on this
side of the water, and there has existed a real desire
for a lull treatise upon this subject. In looking through
the massive treatise of Rindfleisch, a variety of thoughts
suggest themselves, while we are amazed at the im-
mense wealth of knowledge stored up in it. We pain-
fully appreciate the fact that, owing to their deficient
education, how few practitioners are there who Avill be
able to really ma?ter its contents; whereas, if they had
been carel'uUy instructed in this branch in their rudi-
mentary education, what an amount of knowledge they
could attain. The appearance of this book, with its
diversity of subjects, its minuteness of inquiry, and the
light which it throws upon such a multitude of patho-
logical processes as are treated of in it, shows us really
how little we know, and how as yet the majority of
physicians are not sufficiently educated up to it. We
really hope that ere long pathological and normal
histology will be thoroughly taught in all of our
colleges, and then the value of a treatise like this of
Rindfleisch will be increased fourfold.

Rindfleisch divides his work into two parts ; a gen-
eral part and a special part. The general part contains
a lengthy description of the decomposition and de-
generation of tissues, including necrosis and involution,
and the vnrious forms of infiltration. This chapter
covers a wide range, and treat? fully of amyloid infil-
tration, calcification, pigmentation, and fatty infil-
tration. The second chapter of the general part treats
of that important part of pathological histology, namely,
the pathological new formations. Following a very
succinct review of the various cell-theories entertained
by i^rominent German authors, we find a very instruc-
tive consideration of normal growth as a type of patho-
logical development. This very naturally leads to a
general consideration of inflammation, Avhich also in-
cludes a study into the nature of specific inflammations.
After this follows a short but admirable description of
the morbid processes taking place in the development
of the various tumors, which is amply illustrated by
drawings of sections of the various growths.

In his second part Rindfleisch speaks of the lesions of
each apparatus and organ separately under the geneiic
title of anomalies of tiiem. Thus we have — anomalies
of the blood and the places of its formations, especially
of the spleen and lymph glands ; anomalies of the cir-

culatory apparatus, of the serous membrane of the skin;
of mucous membranes, of the lungs, of the liver; of the
kidneys; of the ovaries; of the testicles; of the mamma;
of the prostate; of the salivary glands; of the thyroid
glands ; of the supra-renal capsule ; of the osseous
system ; of the nervous system ; of the muscular system ;
and finally the volume concludes with a copious index
and bibliography. To analyze such a work thoroughly
would require much more space than is at our com-
mand, and we shall confine ourselves to briefly pointmg
out some portions of the work whicli we think are of
more than ordinary interest. Thus the chapter upon
the anomalies of the blood includes a fidl review of the
interesting subjects of the dyscrasi;c, chlorosis, leukte-
mia, and melanajmia, and also a fidl description of
thrombosis, which is particularly interesting in a clinical
point of view and is ably written. The anomalies of the
skin are fully naticed, and in that chapter persons in-
terested in dermatology can find much profitable inform-
ation. The forms of catarrhal and croupal inflammation
are clearly described in the section upon anomalies of
the mucous membranes. We know of no work or
monograph to which our readers can refer where they
will find all the recent views upon the various forms of
lesion of the lungs as they will in Rindfleisch's article
upon that subject. We can say the same of the chapter
upon the anomalies of the liver, and must call particular
attention to the admirable chapter upon the anomalies of
the kidneys, a subject which has lilt ely attracted consider-
able attention in this country, and which is here treated
of in a masterly manner. Though all the chapters are of
very great merit, we will still call particular attention
to those upon the anomalies of the osseous and nervous
system as being particularly interesting to physicians
and surgeons. In considering such organs or apparatus,
the author fully treats of it in a condition of inflamma-
tion, so that in the book we have the fidlest account of
that complex process to be found anywhere. The style
of Rindfleisch is terse and clear, but avc must greatly
regret that his work has not been well translated. As
we read the volumes we are struck with the peculiar
construction of the sentences and general lack of smooth-
ness of the diction. In fact it suggests to the reader the
idea that its translators are not thorough German
scholars, and that they frequently have to make use of
the dictionnry. The general appearance of the work is
highly creditable to the publishers, and we are pleased
to see the illustrations so well done.

Dr. Green entiiles his work an Introduction to Patho-
logy and Mcrbid Anatomy, and with great modesty
states in the preface that he has endeavored to supply
a want greatly felt, and that he wishes it to be con-
sidered as a simply elementary work. He goes over
the subject in hand quite clearly, and his work is writ-
ten in a very pleasant manner; but the reader is con-
tinually struck with the fact that it is too brief, and
that the author does not do full justice to the important
subjects treated of If in a future edition the author
amplifies his work, we think, it will be really valuable.
We think he has taken the excellent French mnnual of
Cornil and Ranvier as his model, and that he would do
well if he treated of his subjects as fully as they are
treated of by those authors.

Criminal Adortion. — Tiie detention of criminal
abortion and a study of foeticidal drugs are ably pre-
sented by Ely Van de Waiker, M.D., of Syracuse,
N. Y., in "^a monograph of eighty-eipht pages, being a
reprint from the Gyneecological Society of Boston.

THE MEDICAL RECORD.

Ueports 0f Societies.

MKDIOAL SOCIKTY^ OF THE COUNT\' OF
NEW YOKK.

Siaied Meetin>/, February 26, 1872.

Dr. Abkaiiam .lAooni, Pkksidkst, in tl.c Chair.

The following pliysifians, recommended by tlie Comi-
tia Minora, were elected to membersliip : George H.
Humphreys, Kdward C. Woodbury, William M. Bal-
lard, Carlos P. Tucker, Alexander F. Liautard, Chailcs
A. T. Krop, James Mitchels, J. W. S. Arnold, Edwin D.
^^orJTan, Jr., liobert S. Prentiss, Thomas IL Pooley,
Horatio Gomez, and Gilbert II. Swezey.

The Pkksident stated that the followincr work had
been donated to the library by its autlior, and ho was
instructed to make suitable acknowledgment: "Die
Gejchiehte der Psychologic nnd der I'sychiatrik in
Spanien, von Dr. J. B. Ullersperger, Wiirzburg, 1S71."

Dr. p. p. Porter, from the Committee on Intelli-
gence, read an interesting report of recent progress in
Theory and Practice of Medicine.

Dr. II. Ai.TMoF, from the same committee, read a por-
tion of a long report on the progress of Ophthalmology
during the past year. The conchu-ion of his report,
and another report expected from the committee, Avere
postponed to the next meeting.

mkteorology of nine months.

Dr. D. II. Goodwillie, chairman, presented the fol-
lowing report of the Committee on Meteorology :

May 20 to September 3, 1871.

Barometer : mean 29.87 inches ; maximum, May 2d,
30.234 inches; mininuim, June 12th, 29.438 inches.

Thermometer: mean, 71.91'^ Fahr.; maximum, July
10th, Or' ; minimum. May 23d, 54.

Rain fell on 35 of tlie above 105 days, making an aver-
age of rain on every third day. On 22 of the 35 rainy
days tliere were thunder-storms. In July rain fell on 14
days, and on 10 of these was accompanied by thunder
and lightning. Hail July IGth. June 18th, rain to the
amount of 2.98 inches, and at 9.50 p. m. a slight shock
of earthquake. Whole amount of rain during the 105
days, 21.35 inches.

September 3, 1871, to February 4. 1872.

Barometer: mean, 29.65 inches; maximum, Sep-
tember 12th, 30.324 inches; minimum, January 23d.
29.592 inches.

Thermometer : mean, 43.24** ; maximum, September
9th 68® ; minimum, January 30th and 31st, 10".

Rain on 26 days, .snow on 7. Thunder-storm Sep-
tember 2Gth. Whole amount of rain, 18.00 inches.

dise.\ses of eight weeks.

Dr. Ch.\p.le3 p. Russel, Chairman, read the report
of the Committee on Diseases :

The Committee on Diseases have the honor to pre-
sent the following report upon the prevalent diseases
in this ciiy from January 1st to February 24th of the
present year— embracing a period of eight Aveeks :

During that time there were reported to the Bureau
of S;mitary Inspection 596 cases of small -pox. 123 of
measles, 613 of scarlatina, 119 of diphtheria, 17 oftvphus
fever, and 54 of typhoid fever. " I

The total registered mortality for the eight weeks I
amounted to 4,294, a weekly average of 537. During

the corresponding period of tlie past year there were
registered 3,996 deaths — a weekly average of 500.
Tiic highest wickly average for the conespnnding
period of cither nf the live pr-.-ceding years was 509 in
1870. Thus far, therefore, the mortality of the prc.«ent
year has been much in excess over that of recL-nt
years.

The greatest mortality occasioned by any zymotic
disease has been produced by smnll-piKr, namely, 192
deaths, a Aveekly aA'crage of 24. It has lluctuated be-
tween 15 and 32 deaths weekly, with no appanMit ten-
dency to diminish. Its proportion of mortality, as
deduced from a comparison of the number of ca.se8 re-
ported Avith the number of deaths registered, has been
32 in the 100. This ])ercentage, however, is doubt-
less too large, as many non -fatal cases escape the ob-
servation of the Board of Health. 47 deaths have
been due to measles — about 6 weekly — a .small number.
ScurJalina has carried off 190 persons, somewhat more
than in the coriesponding period of the past year.
Both of tlie two latter diseases .seem now to be slightly
on the incrca.se. 00 deaths have been ascribed to
diphtheria, and 118 to croups about the usual number.
Whoopiuy-congh has continued very prevalent, its fatal
cases having amounted to 165, over 20 per week. Ty-
phus and typh'iid fever have both been marked by a
very small mortality, having caused but 13 and 34
deaths respectively. 30 liave been occasioned by
remittent fever, an excessive mortality lor the season.
15 i deaths have resulted froin diarrhfral diseases against
145 in the corresponding period of 1871 . The number of
deaths from phthisis puhnonalis Avas, until quite latel}',
comparatively small, much below that in the early por-
tion of last year. But, during the past week, this dis-
ease exhibited a most extraordinary f itality, its deaths
reaching 122, the greatest weekly number ever re-
gistered in this city, the next largest having beenil02,
in the week ending March 4, 1871. The deaths from the
local respiratory affections likewise seemed to participate
in the same unfavorable influences, as they occa-ioned
105 deaths during the week, their Aveekly average having
been only 85 since January 1st.

Twenty-five cases of epidemic cerebrospinal menin-
yitis, or spotted fever. haA-e thus far been reported, of
which 12 have proved fatal. These cases have oc-
curred, almost Avithout exception, in houses of the
very worst hygienic character and surroundings, and
generally in tenements particularly defective as regards
drainage and scAverage. Whether such circumstances
are directly concerned in the production of this peculiar
disease is certainly a question of vast interest to the
profession.

CLINICAL THERMOMETRY.

Dr. Lccirs D. Bulkley read a long and elaborate
paper upon this subject, illustrated by numerous raural
diagrams and tal)le.s. The paper was based on the
essay to Avhich ^A-as awarded the Stevens Triennial
Prize two years ago, and its purpose was not to present a
history of clinical tliermometry. or an epitome of what
it had accom[)lished, but rather to contribute neAv data
for the thermomctrical study of disease, in a s5\siema-
tized record of the experience of the New York Hos-
pital for the three j'ears prior to August, 1809, and to
state briefly the conclusions which that experience
tended to establish.

The number of cases in Avhich a record of tempera-
ture was regularly kept amounted to 337, classified as
follows : typhoid fever, 93 ; typhus fever, 23 ; pneu-
monia, 64; erysipelas, 24; acute rheumatism, 17; re-
mittent fever, 12; intermittent fever, 7; scarlet fever,
7 : phthisis, 19 ; acute meningitis, 9 ; tonsiliiis, 7 ; peri-

THE MEDICAL RECORD.

tonitis, G; miscellaneous, 49. Besides the temperature,
the pulse and respiration were always recorded, and the
doctor had tabulated all the cases under each disease
with reference to these three vital signs. Forty or
fifty of those most interesting, either from their typical
eliaracter or from some other circumstance, were given
in detail, with diagrams showing the curves of the
three signs. Each diagram was the record of an actual
case, and faithfully exhibited every failure of observa-
tion ; there were no typical curves made up from the
generalization of many cases, as in AVunderlich's book.

The nature of the paper piecludes any extended ab-
stract, but we hope to see it published as a monograph.
It is quite time that the wealth of experience, so long
carefully hoarded in the case-books of the New York
Hospital, should be brought out for the use of the pro-
fession. We here confine ourselves to the doctor's
concluding summary of the chief points he considers
established :

" 1. T!ie body heat is maintained in health, under all
conditions, at the uniform standard of 98.4° Fahr.

" 2. Any constant deviation from this constitutes dis-
ease.

" 3. A return to and continuance at this standard
marks the termination of the disease.

" 4. A single high temperature is important.

" 5. The changes of temperature in diseases follow
definite and known courses.

" 6. Variations from these typical ranges of temper-
ature in disease are significant, as indicating a disturb-
ing cau~e.

" 7. An irregular course is more unfavorable than a
uniformly higli range of temperature.

" 8. Different temperatures characterize different dis-
eases, and various days of the same disease.

" 9. Although a high temperature indicates a more
severe attack, no heat under 109° can be considered
surely falal.

'■ 10. The daily study of the pulse and respiration in
connection with the temperature is of great assist-
ance.

'"11. When the temperature and general symptoms
agree, but the pulse disagrees, the two former are to be
relied on.

" 12. When the pulsa and general symptoms agree
in indicating unfavorably, the temperature cannot be
relied on, if contradictory, unless the improvement in
respect to temperature is marked and persistent.

" 13. When pulse and general symptoms agree in a
favorable indication, a liigh or rising temperature
should arrest attention.

" 14. All other means of investigation should be
used in connection Avith the temperature to obtain the
greatest benefit from the latter.

" 15. The continuous daily record of the three vital
signs here represented, in the way exhibited, affords
much aid in the diagnosis, prognosis, and treatment of
disease, by the presentation to the eye of its history in
these res[)ects.

" IC. The systematic record of these three points
may assist in determining, at some future day, the
vexed cpiestion whether the type of disease is chang-
ing, by preserving pictures which can be easily com-
pared."

THE ALBANY MEETING. '

Dr. E. Eliot, as one of the delegates to the recent
meeting of the State Society, gave a summary of its
proceedings.

The Prksidf.xt wished to direct special attention to
the following lesolution adopted at that meeting, and
hoped each member would do his part toward inducing

every respectable practitioner in the county to join the
County Society :

^'licsolued, As the old laws, requiring every physician
in good standing to become a member of his county
medical society, have not been repealed, it is, and
always has been, the duty of every sucli physician to
obey tne law ; and as the penalty for non-compliance
has been removed by law, it becomes a jxnntof honor
for every regular physician to do so. The presidents
and officers of every county society in the State of
New York are requested to use their best efforts to
have these laws complied with."

With reference to the special meeting of February 3d,
the President said that he had been obliged to call it
in accordance with the by-law providing that such a
call shall be made on the written request of twenty
members. Twenty-four names appeared on tiie re-
quest; t\venl3'-seven members attended the meeting,
and of these only five were signers of the call. A
meeting so attended, after full notification, could hardly
be considered to have been a public necessity^- and it
behooved those members whose politeness would not
allow them to refuse an individual their signatures, to
reflect whether they had not also some duty to the
Society m a matter involving expense and the conve-
nience of a large body of physicians.

Adjourned.

Correspontrencr.

BATHING REDUCED TO A SCIENCE.

To The Editor of the Medical Record.

Sir : — It is always pleasant to couple reminiscences
with prospects, particularly when it permits to do
justice to the men of the past as well as to those who
represent the nearest future. Tlie last pamphlet of
Dr. Wilson Fox offers the opportunity of doing both.
In seventy-eight pages lie gives several monographs
illustrating cases of acute rheumatism exclusively
treated by temperature as a remedi/, and almost exclu-
sively managed by temperature as a means of positive
diafjiiosis.

Acute rheumatisms in which, after a course of variable
severity, the temperature suddenly rises from 103°, 104°
to 107°, 108°, 109° F., have so often proved fatal within
a few hours after reaching the latter degrees, that
Wunderlich legards them as pro-agonistic. The uni-
formity of this termination, whatever plan of treat-
ment had previously been followed, induced Dr. W.
Fox to try to treat it exclusively by low temperature?.
He pubhshed last year in the London Lancet veiy
interesting accounts of his first trials; and now details
his success in two cases which had reached, respec-
tively, 110® and 107.3° F. ; both being primary attacks
of the disease, Avhich are more commonly fatal. Dr.
W. Fox does not, however, present his treatment by
temperature as a remedy exclusively adapted to rheu-
matism, but as the remedy for hyperpyrexias at large.
Thereupon the question suggests itself, "What Avill be
the next move?..." An essay on the Trentment of
Apyrexia? . . . Then what becomes of the innumeni-
ble diseases of modern ncsographies in a therapeutic
point of view ? . . . Evidently the subject is too broad
for the columns of a periodical.

These monographs of Dr. W. Fox deserve besides
to be studied as presenting the most complete speci-
mens of diseases and recoveries in which the thermom-
eter almost alone has done all the work of clinic and

THE MEDICAL RECORD.

therapeutic, and the strongest practical indication of
the revolution clearly expressed in the hook on Medical
Tfinperiitiiie by C. A. Wunderlich and K. Scpnin (page
23S), " Tiu-rmometry will soon rule, not only dingno-
sis, but pathology^and thcrapeutios." To consider a
single fact in this prospective revolution, it is interest-
ing to see how Dr. W. Fox advocates and systematizes
the use of water — not as water or as one of the palhies,
but as a carrier of measurable or dosable temperature,
acting pliysiologically in virtue of physical laws.

To render general this application of wut t, Dr. W.
Fox insists unon the introduction in the wards of hospi-
tals of movable bath-tubs, in wliicli the patient could go,
or be immersed, as near as possible from his own
bed. This liappy sng^'estion recalls to mind a mode of
bathing patients which ought not to have been for-
gotten.

'■ Les hiiins sans baignoire" was the title of a little
pamphlet handed to me, in the summer of 18.'35 or '3G,
by a gaunt and weatherbeaten Swiss physician during
my introductory visit to him in a meager Iodizing of the
Qnartier Latin. He was wrapped in one of those broad
blue cloaks in wiiich the Old Guard are represented
falling at Waterloo. Under this historical garment he
was taking his bain sans bai'pioire in a double lial)it of
flannel and water-proof lie never took anv other,
enjoying them especially when going on horse-baok to
visit his patients, several miles away; and the three
hundred and oild patients of his hospital used the same
bathing apparel for many years and liked it very much:
indeed, there was not a single bath-tub in the hospital
of Lauzanne.

For mine host was ue of Avhom it has been said: —
" There are two systems of surgical deligation, the one
handed to us under the name of Hippocrates, the other
Mayor's." He had come down to Paris to have one
of his free liLrhts upon his proposed improvements with
the old fogies of the Academy of Medicine, too nu-
merous to mention : this was Mathias Mayor's yearly
recreation.

Now it seems to me that this forgotten bain sans
baifjnnire would be just the thing which, with slight
modifications, would render easy in hospitals, and pop-
ular among the middle classes the treatment of hyper-
pyrexia by medical temperatures, not only in public
institutions, boarding-schools, naval, military, industrial,
and s:ientific expeditions, etc., but in the homes of the
many who have no bathing facilities. The apparel
would consist of a litrht stand, like the foot-step used
in a library, upon which could be set a covered reser-
voir of a few gallons, having inserted in one of its sides
a rib of glass, showing the level of the liquid, and an
ordinary thermometer to regulate the temperature of
t'le latter. Hence, one pipe or more would let down
the water into the bathing-dress.

This dress — which entirely enrobes the patient, even
if need be his head and some parts of Ids face — is
double, of thick flannel against the skin, and of vulcan-
ized cloth outside. It is also open in the centre, like a
pouch, to permit the insertion of the medical thermom- |
eter in one of the natural cavities, at various points to \
admit the water from the reservoir, and at the feet and j
other declive parts to give issue to the liquid iuto i
covered receivers below.

This bathing-dress could be made as stout or as light I
as desirable; it could be so adjusted as to hardly hold 1
two quarts of Avater, pure or medicated ; mathemat- j
ically warm or cold as per thermometer; stagnant ]
around the body or streaming along it. It could be i
worn for hours, or days, in bed by the paralytic and ;
rheumatic patients, or in the room, even in the open !
air by iho.«e who need at the same time bathing and .

exercise. There are many other advantages of this
bathing-dress too obvious to need mentioning.

The •' apparatus for applying heat and cold to the dif-
ferent parts of the human body,"descril)('d liy Dr. Alex-
ander Kol)ertson, of Glasgow, in the TiOiKlon Medical
Times (Did dazetle of January lijth, 187-, sccmiis more
ingenious than the one here juoposed ; but iheir appli-
cation and object differ so entirely, that where the one
would be useful the other one would be u>elc.ss; but
both could certainly find their place in hospitals and
ambnlances, or be easily supplied to private patients.

Such appears to be, prima facie, the advantages of
the adaptation of Mayor's balh to the therapeutics of
the positive school of medicine of which Dr. W. Fox
is, with his kinsman. Long Fox, one of the most noted
exponents.

It seems that it would be doing an act of justice if
we were giving to this bathing npparel the name of
Mathias Mayor, who was never equalled for ingf-nuity
in the mechanical department of surgery ; and yet who
met with so little of reward that, if he had cared a fig
for a tomb-stone, he Avonld have caused to be written
upon his, '■ Woe to him who comes too soon."

There may be protests against the positions respec-
tively here assigned to Mathias Mayor and to Dr. W.
Fox. Dr. Richard Neale presents his own titles in the
London Medical 'Times and Gazette, Feb. lU, 1372, as
having applied the water treatment under cover of
plantain leaves, etc., and there may be hundreds of ap-
plicants to such claims as his; for, since Priessnitz and
Fleury, the iiydropathist of the late French court, back
to Antonius Musa, the famed hydrotherapeute of the
emperor Augustus, water was uninterruptedly used as
an empyrical remedij. But none used it prior to these
later days as a positive remedy giving mathematical
results : this is what the school to which Dr. W. Fox
belongs pretends to; and to which the bathing appa-
rel of Mathias Mayor may prove valuable.

RespectfuUv Yours,

E. S.
Xew York, Jtarch 0, 1&T2.

ARMY NEWS.

Official List of Changes of Stations and Duties nf Offi-
cers of the Medical Department, United States Army,
from February 21, 1872, to March 4, 1872, inclu-
sive.

WiRTZ, H. R., Surgeon. — By S. 0. 3, Department of
Arizona, January 15, 1872, assigned to duty at Camp
Hualpai, A. T.

Fraxtz, j. IL, Surgeon. — By S. 0. 40, Departmei^it
of the South, Februar}'^ 24, 1872, assigned to dutv at
Columbia, S. C.

Macicin, Chas., Ass'stant Surgeon. — By S. 0. 40,
Department of the South, February 24, 1872, assigned
to duty at Fort Macon, N. C.

Bartholf, j. II.. Assistant Surgeon. — By S. 0. 40,
Department o! the South, February 24, 1872, assigned
to duty at Chester, S. C.

Lauderdai.-:, J. V., As«is'ant Surgeon. — By S. 0. 4G,
War Depai tnient, A. G. , February 24, 1872, granted
leave ol ab ence fur thirty days, with permission to
apply for sixty days' extension.

PowKLi,, R., Assistant Surgeon.— By S. O. 28, De-
partment of the Gulf, February 20, 1872, a-s'gned to
duty at Jackson, Mis.«., relieving Assistant Surgeon A.
A. Yeomans, U. S. A.

THE MEDICAL RECOED.

Kimball, Ja?. P., Assistant Surgeon. — By S. 0. 42,
War Department, A. G. 0., February 19, 1872, to pro-
ceed without delay to New Orleans, La., and report to
the Department Commander.

CowLES, Edward, Assistant Surgeon. — By S. 0. 44,
War Department, A. G .0., February 21, 1872, Lis
resignation accepted, to take efFect March 1, 1872.

EDWAi:ns, L. A. Surgeon.— By S. 0. G3, War De-
partment, A. Gr. 0., March 14, 1872, reheved from duty
in Department of Texas, to proceed to Philadelphia,
Pa., and thence repoit to the Surgeon-General.

IIamjcond, John F., Surgeon. — By S. 0. 63, War De-
partment, A. G. 0., March 14, 1872, to report to the
Commanding General, Department of Texas, for duty
as Medical l3irector.

WiRTZ, H. R., Surgeon.— By S. 0. 60, War Depart-
ment, A. G. O., March 11, 1872, upon arrival of Assist-
ant Surgeon Girard, in Depanment of Arizona, to re-
port to the Commanding General, Department of Cali-
fornia, for assignment to duty.

Bache, Dallas, Surgeon. — By S. 0. 57, War Depart-
ment, A. G. 0.. March 7, 1872, relieved from duly in
Department of Texas, and to report in person to the
Surgeon-General.

Ascn, M. J., Assistant Surgeon. — By S. 0. 61, War
Department, A. G. 0., March 12, 1872, granted leave
of absence lor six months.

McElderry, H., Surgeon.— By S. 0. 61, War De-
partment, A. G. 0., March 12, 1872, after accompany-
ing the first detachment of recruits sent to the Pacific
Coast from New York, to report in person to tlie Com-
manding General Department of the Columbia, for as-
signment to duty.

Girard, J. B., Assistant Surgeon. — By S. 0. 60, War
Department, A. G. 0., March 11, 1872, to report to
the Commanding Officer, Department of Arizona, for
assignment to duty.

Kimball, James P., Assistant Surgeon. — By S. 0. 33,
Department of the Gulf, March 4, 1872, assigned to duty
at Little Rock, Arkansas.

Mofj'att, Peter, Assistant Surgeon. — By S. 0., GO,
War Department, A. G. O., March 11, 1872, assigned
to temporary duty at Newport B'ks, Ky.

KixG, J. IL T., Assistant Surgeon.— By S. 0. 62,
War Department, A. G. 0., March 11, 1872, to report
to the Commanding General, Department of the Piatte,
for assignment to duty.

CoRSox, J. K., Assistant Surgeon. — By S. O. 20,
Middle Division of the Mo., leave of absence extended
thirty davs.

iHctiical Jtcms antr lletus.

■ University Medical College, N. Y. — Dr. Joseph
W. Howe has been appointed clinical Professor of Sur-
gery ; Dr. Henry S. Hewit, Professor of Clinical Surgery ;
Dr. Arnold, Professor of Pathological Anatomy ; and
Dr. Kammerer, Professor of Diseases of Women and
Ohildren, vice Dr. F. D. Lente, resigned.

The Pharmacy Bill has been reported favorably
from the Health Committee of the Assembly. Dr.
Loughran, of Kingston, the Chairman of that Commit-
tee, we are happy to say was one of the principal
means to that end.

Acid Syrup of the llYPOpnospiiiTK of Ltme in Vomit-
ing OF Pregnancy. — Dr. A. F. Paitce, 13oston, sp(;aks
very highly of the use of this syrup in the obstinate
cases of vomiting in pregnancy. The dose ranges
li'om 3j-5^s, given with the Ibod, three or lour times
a day.

The Alumni Association College of Physicians and
Surgeons held its annual meeting at the College of
Physicians and Surgeons, Tuesday, Feb. 27, 1872. The
meeting was called to order by the Vice-President,
Dr. C. R. Agnew. After the reading of the minutes
of the previous meeting by the Secretary, Dr. John
Shrady, the same gentleman read the obituary record.
The Prize Committee through its Chairman, Dr. Gur-
don Buck, announced the award of the Alumni Prize
of four hundred dollars, to Dr. Frank P. Foster. The
election of officers was then held with the following
result. President, Dr. C. R. Agnew, N. Y. ; Vice-
President, Dr. Robert A. Barry, N. Y. ; Secretary, Dr.
John Shrady, Harlem, N. Y. ; Assistant Secretary,
Dr. A. Norton Brockway, Harlem, N. Y. ; Treasurer,
Dr. J. L. Banks, N. Y.

The President. Dr. E. M. Hunt, of Metucliin, N. J.,
gave a scholarly addiess upon the past and present in
medicine which was full of wholesome reflections and
suggestive thoughts. The address was ordered to be
printed.

A discussion then arose bearing upon the expedi-
ency of increasing the usefulness of the Association by
making the reunions partake more of a sociable charac-
ter. The sentiment of the meeting was in favor of
refreshments, and the whole matter was left to a com-
mittee to whom Avas voted the usual discretionary
power. The meeting then adjourned.

Bellevue Hospital Medical College. — The follow-
ing changes have lately been made in the Faculty : —
Prof. Stephen Smith has resigned the chair of Descrip-
tive and Comparative Anatomy, and Clinical Surgery.
Prof. B. W. McCready has resigned the chair of Mate-
ria Medica and Therapeutics and Clinical Medicine, and
has been appointed Emeritus Professor of Materia Me-
dica and Therapeutics and Professor of Clinical Medi-
cine. Prof. A. B. Crosby has been appointed Professor
of General, Descriptive, and Surgical Anatomy. Prof.
Wm. A. Hammond has been appointed Professor of
Materia Medica and Therapeutics, Diseases of the Mind
and Nervous System, and Clinical Medicine. Prof.
Hammond will continue his lectures and clinics on Dis-
eases of the Mind and Nervous System as heretofore,
lecturing also upon Materia Medica and Therapeutics.
Dr. E. G. Janeway has been appointed Prof of Patho-
logiS,l and Practical Anatomy. As Prof, of Pathological
Anatomy, he will deliver in the regular session a course
of lectures on that subject. As Prof of Practical Ana-
tomy, he will perform the duties of Demonstrator of
Anatomy. Dr. E. L. Keyes, formerly Lecturer on Der-
matology, has been appointed Prof, of Dermatology.
Prof A. B. Mott has been transft-rred from the chair of
Surgical Anatomy, with Operative and Chnical Sur-
gery, to the chair of Clinical and Operative Surgery.
Prof. Mott will relinquish his didactic lectures on Sur-
gical Anatomy to the Prof, of Anatomy, and will hold
a Surgical Clinic at the college throughout the year.

College of Prysicians and Surgeons. — Beecher's
Address. — The following extracts from our notes of
Kev. Henry Ward Beecher's address to the graduates,
at the Commencement of this college, could not find
sjiace in the last number.

After encouraging the students to work earnestly and
wait patiently for opportunity, recognition and dis-

THE MEDLCAL REC;ORI).

ti net ion, sure that finally success would follow desert,
tlie speaker touched upon the motives that should im-
pel ati'l Hiistain them. Tiie desire of pain, personal
ambition, love of seientific truth, synipaihy for indi-
vidual suftVrincr, an 1 tin; broader sentiincMit of pliilan-
thropy, reinforced by religion, were tiie steps liy which
I hey could mount to a plane of high thought and worthy
action.

The spread of cidture among the common people was
rapidly changing the status of the medical profession, as
of every other, eurlailing its lower functions, to extend
and muUi|>ly its higher ones. " Take my own pro-
fession," said the speaker. "There was a time when it
was hardly right for a man to be born without the
priest to sanction it; and all throujih life, at every turn,
he must call in the priestl}- aid and counsel. Now, men
not only are born, but t'.iey marry and die Avithout our
help; tliey have appropriated to themselves a thousand
oftices that were once our sacred and exclusive privilege.
But we have gained far more than we have lost ; have
been deprived of those manifold duties which were
hindrance*, only to give us freedom for broader and
higher growth ; and I rejoice in it. So in medicine.
The intelligent mother is now your rival. The laily
know more than the wisest of you did two or three
centuries ago. Yet the field of your own work is not
narrowed, but marvellously enlarged ; and it is destined
to be extended more and more with the advance of
science and it«s popular recognition. It was thought
that machines would throw the workman out of em-
ploy, but instead they only took slave's toil out of his
hands, and drove him into better service, for which
they created a new and ever-growing demand.

"You are no longer to be simply ministers of healing
to the sick ; a large part of your future duty is to be
toward the well. The community looks to you to
develop and enforce the whole science of private and
public hygiene ; it looks to you, moreover, for instruc-
tion in mental and moral philosoph}'.

" I do not undertake to say that mental philosophy
will ever be established upon the basis of physiology
alone ; but I do say that without the support of phy-
siology there will never be a stable philosophy. While
I believe there is much more blossoms out in mind
than mere nerve-substance, yet I believe, also, there are
no men in our day so near the secrets to be revealed
as the physiologists, nonC who are so likely to help us
throw light upon the mysteries of intelligence it>elf.

" I said you were to rectify our moral philosophy
as well. Tiie law of God was not all written on !Mount
Sinai ; He has been writing upon every mountain since.
All of truth is not contained in the inspired record.
God has not ceased to think, or to reveal his thougli^ A
part of this revelation is in our own physical constitution ;
and in the progress of truth we are to learn what is the
connection between bodily conditions and moral states.
I say, as the result of long observation and experience,
that, very largely, the causes of wrong-doing are mor-
bid conditions of body and unfavorable circumstances.
We need not fear that this doctrine will destroy respon-
sibility. There is enough in the fact that men know
when they are doing wrong to secure that. I aver,
then, that a sick man can hardly be a moral man ; can
hardly conduct himself as a free moral agent, when
every nerve and fibre of his body is crowding tempta-
tion upon him. There is sin enough in one single
organ, the liver, to call it the devil's den. You are to
interpret for us this connection between physical and
moral disease ; to help us clear the way for larger con-
ceptions of life and duty.

" It is impossible that the mass of men can be healthy,
and so moral and successful, without some knowledge

of their structure and of its laws which they must obey
or KufTer. How can a young woman he called educated
who is ignorant of physiology, of iier duties as a mother,
of the divine art of nursing? How numy men know
anything of th(! relations of waste and supply in the
nervous economy? Why, not one man in a hundred
knows even what the stomach is made for, and the
other ninety-nine are constantly transgres.-ing rules
they have never learned. We may take the old para-
ble of the apple in the garden as an illustration of the
way men's stomachs make havoc with their moral sense.
Not one man in a hundred knows or suspects that God
made the air to be breathed. Every part of his house
may be reeking with miasma, the cellar full of all evil,
the partitions clotted with dormant mischief, and he
never dreams of it, but goes on nailing down his win-
dows and listing his doors. If we could only see the
air we have once breathed over! Even the architects
of our public halls and theatres and churches have the
crudest notions of ventilation. I have found .=ad proof
of this in every part of the L'nited States, and you will
agree with me that we have no exception here to-night.
To whom shall we look for the diffusion of knowledge
on these subjects among the people, if not to you?
Every family in which you practice should be made a
medical school.

" From private hygieric, we pa=s to public, which we
have hardly begun, as yet, to understand and apply.
You must take the lead in directing the removal of
those great morbific influences that prey upon the life
of the community. Thousands upon thousands of
cradles are yearly emptied, long streets are turned into
shambles, from causes that should not be suffered to ex-
ist. The great questions of the sewerage of cities, the
draining of morasses, and a hundred others, are pressing
upon us for answer; and of whom have we a right to
demand it, if not of the medical profession?

" It devolves, then, upon the physicians of this age to
make themselves felt as a power in public as well as in
private. In every 'effort to elevate the standard of
personal purity ; in every discussion of the best means
of preventing crime ; in every attempt to gain a soimder
philosophy of education, and to apply it in the direc-
tion of public institutions, or in the training of individual
children — the physician is to be not only the adviser of
the family, but also the counsellor of the community,
whose word should be heeded as always important and
often decisive."

S.MALL-POX in New York still holds the weekly ave-
rage of seventy-four.

Dii. B. F. MiESSE, of Chillicothe. Ohio, recently sued
for malpractice, has been acquitted. From the evi-
dence given at the trial, it was proved that the case,
which was one of fracture of the thigh, Avas skilfully,
carefuU}', and conscientiously treated. Another case oi
malpractice is in progress in that vicinity, but if the
profession stand by each other as in this case, the re-
sult can be easily anticipated.

United States Marine Hospital Servick. — Jno. M.
Woodworth, Supervising Surgeon U. S. Marine Hos-
pital S^-rvice, Treasury Department, submits a com-
parative statement of the operations of the United
States Marine Hospital Service for the six months end-
ing December 31, 1871, and the six months ending De-
cember 31, 1870, showing the number of days of hos-
pital relief and the amount of expenditures incurred for
the care and treatment of sick and disabled seamen ; also
the amount of hospital tax collected during the same
periods. The reduction of the expenditures during the six
months ending December 31, 1871, over the six months

THE MEDICAL RECORD.

ending December ."il, 1870, amouiils in the aggregate
to over $40,000, -which saves seventeen per cent, to
the fund. Tlie amount of hospital tax collected during
the last s-ix moullis uf 1871 is ten per cent, greater tlian
the amount collected during the corresponding six
months of 1870 under the opcra'ion of the same law.

Alumni Association Medical Department of tiik
Univeksity of New York. — The annual meeting of this
Association was held at the Chai)el of the Collegiate
Eeformcd Dutch Church, corner Fifth avenue and
Twenty-ninth street, on Thursday evening, March 14th,
1872. Dr. F. D. Lente, President, in the Chair. Tlie
exercises were opened with prayer, by Pi'oC. Benjamin
N. Martin, D.D., L.H.D., followed by appropriate intro-
ductory remarks from Prof. Charles A. Budd, class of
1852. Prof. D. B. St. John Roosa, class of 1860, then
delivered an excellent and impressive address, in which
the followingpoints were dwelt upon. That medical edu-
cation is to be advanced through the medical colleges ;
with three exceptions, the medical works published
during the past year by a well-known publishing house,
were written by professors of medical colleges ; and of
ten papers read before the Medical Society of the Coun-
ty of New York, during the same peiiod, six were by
medical professors ; the Harvard Medical School, having
raised the standard of medical teaching, should have
the profession of New England at its back ; the Medical
and Surgical Histories, written by Drs. Woodward,
Otis, and others, under the direction of the Surgeon-
General, cannot be suipassed by foreign autliors; the
diseases of our day are of a more refined nature than
those of a hundred years ago, and paralytic diseases, and
those of the eyeball are on the increase — as shown by
statistics; many of the teachers in our medical schools,
who lecture on special topics, are not allowed to parti-
cipate in the examination of students for a degree — ne-
cessitating a radical change in the present system of
medical teaching; in 1841, New York City had only
one hundred medical students; now, in three schools,
there are over one thousand endowments for professo-
rial cliairs; libraries and scholarships are much needed;
men who hold four or five hospital appointments, and
are canditlatcs for more, should give up some of them
to those wlio would be willing to give the profession
the benefit of their experience. The relations of medi-
cal men to the laity were fully discussed in the second
part of the paper ; and an allusion was made to the un-
wise decision of the governors of the late New York
Hospital, in the removal of that time-honored Institu-
lion from a section of the city where it was so much
needed. He thought if the Medical Board of that hos-
pital had an active part in the management of its affairs,
it would have remained on its old site to this day.

Following the acceptance of the paper and benedic-
tion, !he following business was transacted : Drs. F. D.
Lente, James R. Leaming, and James H. Anderson were
appointed a Committee to investigate the charges made
against the University in an article to appear in the
Medical Record. The officers ibr 1872 are as follows :
President, James R. Leaming, M.D. ; Vice-Presidents,
Henry S. Hewit, M.D., Solomon S. Satehwell, M.D. of
N. C, Charles A. Budd, M.D., Samuel M. Bemiss, M.D.
of La., Wm. Canniff, M.D., of Canada, Theo. R. Varick,
M.D., of N. J. ; Secretary, Charles Inslee Pardee, M.D. ;
Treasurer, D. B. St. John Roosa, M.D. ; Orator, Solo-
mon S. Satehwell, M.D. ; Executive Committee, Drs.
James H. Anderson, Stephen J. Clarke, Francis V.
White, F. Le Roy Satterlee, and Joseph T. Moneli.

The Presbyterian Hospital, Phila.— At a meeting
of the Trustees of this hospital, held Feb. 19th, the fol-
lowing medical oflicers were elected •.— Consulting Sur-

(jeons, Drs. Samuel D. Gross and D. Hays Agnew ; Con-
sulting Physicians, Drs. J. L. Ludlow and Jacob M. Da
Costa; Attending Surgeons, Dns. Thomas B. Reed, Os-
car H. AUis, H. Lenox lloilge, and William G. Poiter;
Attending Pltysicians, Drs. Edward Wallace;, S, Weir
Mitchell, J. Forsyth Meit^s, and D. Flavel Woods ; Ob-
stetricians, Drs. Robert M. Girvin and John S. Parry ;
Ophtlialmic Surgeons, Drs. W. Wallace McCJme and
(jeorge Strawbridge ; Pathologist, Dr. Dc Forest Wil-
lard.

The Dental Profession. — Oliver Wendell Holmes,
M.D., in his address at the Commencement Exercises
of the Dental Department in Harvard University, Feb.
14th, after alluding to the fact that the teeth were par-
ticular objects of attention in the time of the Egyptians,
says that from the time of Galen to the middle of the
seventeenth century, he has not found any other traces
of a special dental profession until he came upon the
following: Lr the Diary of the Rev. John Ward, Vicar
of Stratford-on-Avon, from 1648 to 1679, are the^e
lines: "Upponasigne about Fleet Bridg this is written,
' Here lives Peter de la Roch and George Gollin, both
which, and no other, are sworn opei'ators to the King's
teeth.' " In 1820 there was not more than a hundred
dentists in the United States. In 1858 there were
4,000. Since then they have increased in as rapid a
ratio. — Boston Med. and Surg. Journal.

The Medical Department of the University of
Pennsylvania, March 12th, graduated a class of eighty-
three students. Thirty-four students received diplo-
mas, Feb. 15ih, at the Commencement of the Massachu-
setts Medical College. At the Commencement of the
Medical Department of the University of Buffalo, held
Feb. 20th, thirty-four students received the degree of
Doctor in Medicine from the hands of the Chancellor,
Hon. Millard Fillmore. The address to the graduates
was delivered by Prof. James P. White.

The Epidemic of Small-Pox in Chicago. — When the
epidemic of small-pox commenced in Chicago, an order
was passed that, after a certain date, none of those re-
ceiving rations and aid from the Relief Society should
have anymore food, clothing, coal, etc., without present-
ing a certificate of vaccination, or of revaccination. This
legislation, impossible elsewhere, and heretofore, over-
came the objections of the ignorant against vaccination,
and has served to stamp out the epidemic- One thou-
sand persons were vaccinated daily for several Aveeks,
the expense being borne by the Relief and Aid Society.
The highest mortality from this disease in that city,
according to the U. S. Med. and Surg. Journal, in any
one week has been only sixteen.

East River Medical Association, N. Y. — The fol-
lowing officers were recently elected for the ensuing
year : President, Dr. Henry E. Crampton ; First Vice-
President, Dr. Daniel E. McSweeney; Second Vice-Pre-
sident, Dr. Samuel Blume; Secretary, Dr. William J.
Purcell ; Treasurer, Dr. Verannus Morse.

Medical Electricity. — Dr. Roberts Bartholow, of
Cin., contributes to the Clinic of Feb. 24th, with illus-
trations, an instructive article on Medical Electricity
and Medical Electrical Apparatus.

Appointments. — Dr. A. 0. Kellogg, for nine years an
Assistant Physician in the New York State Lunatic
Asylum, has resigned, and accepted a like position in
the Hudson River Hospital for the Insane ; Dr. J. M.
Cleveland, Superintendent. Subsequently, Dr. Jud-
son B. Andrews, Second Assistant Physician in the
New York State Lunatic A-;ylum, was appointed first

THE mp:dical record.

Aasistant; Dr. Walter Kerapster, third Assistant Phy-
sician, wjis appointed second Assistant, and Dr. Daniel
II. Kitchen, of New York city, was appointed third
As-sistant I'hysician, to All the vacancy. — American
Jo n rnal of In sa n itij .

Medical B.\roxkt3. — Thirty-one physicians and
thirteen surpeons have heen created baronets in Eng-
land since 1<)45. Tlie first medical baronetcy, that of
Sir E. Greaves in U»45, is disputed ; but of the si-cond,
that of Sir Hans Sloane, practically the founder of the
British >riiseum, there can be no doubt.

Nkw YoitK Mkdico-IIistorical Socikty. — At tlie an-
nual meeting of this flourishing organization, held re-
cently, the following oflicers were elected for the en-
suing year: — President, William T. White, M.D. ; Secre-
tary and Treasurer, Zo\\n G. Frazer, M.D. ; Editor, Al-
fred E. M. Purdy, M.D. ; Diarist, Bradford S. Thomp-
son, M.D.

Tiu: WiTtii-M.\NiA OK THK Sevkxtekntii Century. —
Joseph Workman, M.D. {Am. Journ. of InsanHij). states
that it has been calculated that from 1G03 to 1G80 the
total put to death, by regular legal process alone, was
about 70,000 ; and if, in the ten years of exclusion of
the Stuarts from the tlirone, over 35,000 witches were
destroyed, the annual number must have been over
35,000, or nearly ten per day, Sundays not excluded.

St. Vinxext's IIosimtal. — From the annual report of
this Hospital, founded in 1849, it appears that 9G5 pa-
tients Were treated during the past yeai-, of whom 53G
Avere discharged cured, 185 improved, 49 unimproved,
118 died, and 87 remain. In the surgical department,
271 patients were operated on, of whom only 8 died.

ALCOnoLic Spirits Conscmed ix the United States.
— The cost of the clergy of the United States is esti-
mated at $12,000,000 annually ; while that of criminals
is §40,000,000, and of spirits $000,000,000. The re-
searches of Otis Clapp, of Boston, Mass., in 18G9, give
the loss to the productive power of this country,
through intemperance, at from 10 to 20 per cent. At
10 per cent, only, the loss on the agricultural and manu-
facturing interests reaches the sum of $450,000,000.
The census of 1870 will probably show this sum to be
vastly increased, and perhaps doubled.

Electricity in Diseases of the Skin. — Dr. George
M. Beard, Xew York {American Journal of Syphihgra-
phrj and Dermatology) says that it is yet too early to
lay down special conclusions concerning the prognosis
of different diseases of the skin under electrical treat-
ment; but from what has already been accomplished,
the general proposition seems to be justiliable. For
many cases of psoriasis, eczema, anaesthesia, pityriasis,
and prurigo, that under ordinary treatment are obsti-
nate or incurable, electricity is of such great efficacy,
both temporary and permanent, as to entitle it to a
very high rank among the resources of the dermatolo-
gist.

A New Hospital for Animals has been opened in
Dublin, known as the " Brown Institution." A large sum
of money was bequeathed fur the purpose, in 1852,
to the University of London. On llie Committee of
Directors are Drs. Busk, Carpenter, Gull, Quinn,
Sharpey, Sibson, and Simon. Dr. Burdon Sanderson,
of University College, has been made professor. It is
expected that the institution will add very much to our
facilities for acquiring a knowledge of the action of
remedies and the causes of disease. Although the
laboratory is intended for research rather than instruc-
tion, it will be open to all who wish to engage, on

their own account, in scientific inquiries, providing they
show evidences of previous scientific trainin;.', and pay
their own expenses*

Ai-coiioi.iSM. — Dr. Paluel de Marmon, of Kingsbridge,
N. Y., in a rc^priiit from the Medicil World, discusses
tlie " Medico-Legal Con8ideration.s upon Alioholism, and
the Moral and Criminal Responsibility of Inebriates."
He states that in ninety cases of a hundred, drunke-nnes
is first contracted by imitation and politenes.s; for it is
considered very impolite by some to refu-e to drink
when invited so to do. Anotiier cause rests principal-
ly in this country upon the bar-room system. Febru-
ary 1. 1871, there were 7,0U0 dram-shops or hotels j»ay-
ing license, under the Excise Law, in New York City,
and, on the authority of an officer of the department,
there was an equal number selhng without license,
which would make 14,000 drinking places in New York
alone — one for every Go inhabitants. The report of
Messrs. Otis Clapp, John E. Tyler, and Wm. B. Spoon-
er, made to the Lcgi.slaiure of Massachusetts, esti-
mates that there arc 000,000 persons in the United
States who have lost their power of self-control in the
use of intoxicating liquors, and that in Massachusetts
there are 23, (KM), of whicli number two per cent, die
each year a drunkard's death. Dr. Marmon suggests
the abrogation of the bar-room system as the best
means to cut .short this human plague.

Demonomania and WiTcricRAFT, — The.se subjects are
pleasantly discussed by Joseph Workman, M.D., in a
paper read before the Association of Medical Superin-
tendents of Insane Hospitals, in Toronto, June, 1871,
and published in the October No. of the American
Journal of Inmnity. He says that it is not to be ex-
pected that the foolish doctrine of belief in diabolic
possession, which, less than two centuries ago, perva-
ded the whole of Christendom, and was preachetl from
every pulpit in our own and mother countiie-, and pro-
claimed from every bench of justice, could utterly die
out among the uncultured masses in any very short
lapse of time. He has met with persons, not insane,
who have avowed their belief in its present existence,
and relates the case of a clergyman, who fled from the
room where an insane woman was suffering from hj-
cantliropia, and when he recovered his mental equili-
brium, said " ! Doctor ! that woman is possessed ! "

Customs and Salaries of Physicians before the
Christian Era. — Boerhaave observes that before there
were any professed physicians, it was the cus'.oni
among the ancient Egyptians, when any one was sick,
to inquire of neighbors and passengers if they knew ol'
any proper remedies for the patient. But ever sine.-
the study of physic became a profession, it has been
both honorable and lucrative. The customary yearly
salary which princes paid their physicians, about tht
time of Christs birth, was 250 sestertia, or abov'
2018/. sterling. Stertenius complained that he had
only a salary of 5t)0 sestertia, or 4036Z. Os. 2d. sterling. "
when Ke had by his private practice GOO sestertia, or
4843/. 15s. — TJr. Arbuthnofs Book on Coin, and Mi-.
William Smith's Book of Bemarks on the same Subject.

Uctu publications.

Books Received.

Earth as a Topical Applicatiox ix Surgery. By
Addixell Hewson, M.D., Attending Surgeon, Penn-
sylvania Hospital, Phila. : Lindsay ifc Blackiston. 1873.

THE MEDICAL RECORD.

Original Commumcations.

THE MODERN OPERATION FOR STRA-
BISMUS.

Bv E. G. LORING, M.D.,

NEW YORK.
RKAD BEFORE NEW YORK ACADEMY OP MEDICINE, MARCH 7, 1872. I

It is with the hope of presenting to those of you wlio
have not time to search through the various mon- j
©graphs for more detailed information, a dight sketch
of this important siilject as it stands at present among
ophthiihnoloLtists, tliat I now offer these remarks, and I
witli the hope of pointing out some of the most impor-
tant considerations, both as to cause and effect, on a
subject in regard lo which the general practitioner must
oftentimes be consulted prior, if not in preference, to
the ocul'st.

In regard to the etiology of the complaint, it was
ascertained by the labors of Bonders, and others, that
strabismus occurred in 80 to 85 per cent, in hyperme-
tropic eyes, or e3-e5 which were congenitally deficient
in focalizing power. Without wishing to impugn
this statement in tiie slightest degree, it has, neveithe-
le?p, always struck me that an exaggerated importance
has been given, not only by Bonders himself, but by
all others, in regard to the share which the shortened
antero-posterior axis really plays in the production of
squint; for it must be borne in mind that emmetropia,
or a perfectly normal eye, is a rather poetical condition,
and trifling deviations from the normal standard, though
sufficient to justify a classification of eyes in regard to
refraction, cannot be sufficient to be the active cause of
sirabismns. Thus it is hardly fair to suppose that a
young child who has a strabismus of some 3 or 4 line?,
and whose total deviation from the normal standard
amounts to a convex glass of -'- or Ai, squints, because
it i-5 unable to neutralize this very trifling defect by the
action of the ciliary muscle. This attributing the pro-
duciion of strabismus almost entirely to the existence
of congenital far-sightedness, no matter how trifling it
may be, has led Bonders and others to criticise some-
what sharply, and somewhat unjustly, the statements
made by general practitioners, backed up by those of
nurses and mothers, that tlie squint in a given case
had been caused by an attack of measles, whooping-
cough, SL-arlet fever, or any of the thousand and one
depressing maladies which are incident to childhood.

Blinders has averred that if these cases are critically
examined it will almost invariably be found that hyper-
metropia is at the bottom of the evil ; and less renowned
and less discriminating practitioners, following in his
footsteps, have gravel}'', if not supercilionsl}^, waived
away the convictions of the parent and family phy-
sician, with the calm assurance that the child was
born, if not with the fruits, at least with the seeds of
the malady, and the cause t > which they attributed the
evil had nothing to do with it. Now, I myself have
frequently seen strabismus produced in children imme-
diately after some sickness, when there was no error
in the optical condition, and pass away again as soon a.s
the strength of the patient was restored, from which
1 have been forced to the conclusion, rather a self-evi-
dent one. I admit, that wherever and from whatever
cause the combined force of the ciliary muscle and in-
terni recti is greater than that of the externi, there also
strabismus is apt to occur; and that such a state of af-
fairs will take place more Irecpiently in far-sighted eyes
th in in others, follows as a matter of course.

But the point which I wish to emphasize is, that a
transient reduction in nervous foice, with over-exertion
at su'.'li a time, may produce in emmetropic, or even in
slightly myopic eyes, precisely the same factors favor-
able to the production of strabismus Avhich exist through
congenital structure in a hypermetropic eye. In other
words, that such eyes, under the debilitating influences
of disease, do become, practically speaking, lor the time
being hypermetropic eyes, and are forced, from a reduc-
tion in focalizing power, precisely like hypern.etropic
eyes, to use a dispioportionately large amount of ac-
commodation with moderate degrees of conveigence.

So, too, a slightly hypermetropic eye, which, while
t'lie general health was undisturbed, would never mani-
fest the slightest tendency to turn in, may become, when
reduced in strength, equivalent to one of great degree,
with its accompanying tendency to become ciossed.
And the practical lesson which I would draw from this
is, that the general practitioner should be particularly
on his guard not to permit his young patients, in tlie
earlier days of convalescence, the indiscriminate use of
their eyes, especially when confined to the bed, on
books and toys and other occupations, which are often
carried on with an intensity of purpose and an expendi-
ture of nervous Ibrce, which, if applied in its weakened
condition to any other organ, would end in its utter
overthrow.

The first step in the operation is to pick up the con-
junctival and subjunctival tissue lying over the inser-
tion of the tendon to be divided, which should be done
with enough firmness to insure a not inconsiderable fold
ol' the conjunctiva between the arms of the forceps ; for
if this is not done, it will be found that Avhen the open-
ing is made the scissors will glide beneath the conjunc-
tiva alone; and th.e subconjunctival tissue, together
with the extension of the capsule of Tenon, will have to
be divided separately, which will necessitate a new hold
with the forceps. Nor must the first incision with the
scissors be, as is often recommended in the books,
immediately at the corneal margin, but removed from
it about a line and one-half, and just in front of the
implantation of the tendon. This leaves a narrow
line or bridge of conjunctival tissue still attached to
the cornea, which is often of great service in the finish-
ing of the operation, and which will be further dwelt
on.

But the principal difficulty, which is experienced by
even those who have performed the operation repeat-
edly, lies in the easy and successful passing of the hook
Ijcneath the muscle so that the insertion shall be
plainly exposed. And this difficulty is occasioned by a
disregard of the anatomical distribution of the capsule
of Tenon. This capsule, as you are aware, starts from
the optic foramen, surrounds the optic nerve, and then,
spreading out over the bulb, forms a cup-like cavity^ for
tlie posterior half of the eye, in which the eye revolves.
Anterior to the equator, however, the capsule is
pierced by the muscles which pass directly through
it, to be afterwards implanted in the sclera. At the
place of perforation of the muscles the capsule of
Tenon sends out reflections, which, joining with the
connective-tissue sheaths, extend not only backwards
towards the origin of the muscle, but also forwards to-
wards the insertion where the capsule becomes mingled
with the conjunctiva. In the anterior part of the eye
adhesions also take place between the capsule and the
sclera by the means of filamentous bands extending
from the former to the latter. The effect of all this is
to form, so far as the anterior part of the eye is con-
cerned, a sort of sheath or sleeve in which the muscle
is enclosed.

Now the common way of making the opening

TIIK MKDK Al- RECORD.

into the conjunctiva is to continue with the sciesors
directly back in a lino with the belly of the muscle
till it is juJgi'il that n suflioient openiii;,' is made; the
hook is then inserted, and the operator is often sur-
prised to find that, atU-r one or iwo attempL^, it does
not plide beneath the tendon. Tlieopeninjj in the con-
junctiva is enlarged, wiien a more determined effort is
madt>, and it is Ibund thai this time, allhon<^'h the in-
sirninent did not pass cleatdy as it s-iiould beneath tiic
tendon, the point is covered by some portion of the
niusi'le, which is hastily divided, and the operation
is tinished as it began, in sncce-sivc attcmpt-f to fish up
and divide the remaining attachments of tiie tendon.
t)r it may be in another case that, after a liitle violence,
something is felt to give way, and the hook then
glides with the utmost ease beneath the nmsele, with-
out the operator pausing to think what was tlie cause
of the dilliculty in the first place, or the succc.-s in the
latter. This was evidently due to the fact tliat the
hook, in being rotated to pass behind the muscle, came
in contact with the wall formed by the capsule, and
either could go no farther, or, by carrying the capsule
with it, proceeded far enough to just engage the muscle
so as to hook it up by the centie, as it were, without
fully passing behind it. Now the density of the capsule
vanes in different cases, and sometimes with using a
little force we are able to pusli the hook through it, and
then of course it is plain ijailing. Sometimes, however,
the capsule is so strong that the eye is carried before
the hook and made to rotate in large circles in the or-
bit, and the ditficulty of getting beneath the tendon is
increased.

I think, however, that all these difficulties can be
almost invariably avoided if, after getting through the
conjunctiva, ins;ead of dissecting directly backwards
parallel with the belly of the nmsele, we carry the
point of the scissors in a bold, free manner obliquely
across the insertion of the tendon, almost at right angles
to direction of the muscle, till we get into the loose tis-
sue beyond ; by this little manoeuvre we make a small
hole directly through the conjunctiva and subconjunc-
tival tissue, and at the same time through the capsule
and the processes which attach the muscle to the sclera.
If then, on withdrawing the scissors, we gently raise the
edge of the wound, the hook passes with the greatest
ease beyond the horizontal edge of the muscle, and falls
at once by the well-known movement of rotation
directly beneath it, so that when the conjunctiva is
gently drawn over the distal end of the hook the ten-
don lies exposed for its entire length. This beinof
the case, it only remains to divide it, and in doing this
it is an essential point never to begin at that part of the
hook which is nearest the shank, but at the distal end,
and to gently raise the point of the hook as it is grad-
ually dissected out, so as to prevent it from disengao^inf
itself from the muscle till the tendon is thoroughly
divided.

It was formerly thought an advantage to make the
opening in the conjunctiva as small as possible, and to
make the section of the tendon as subconjunctival as '
circumstances would permit. But dividing the muscle ■
in this way is rather a tonr de force than any practical '
advantage, even if it could always be done with cer- '
tainty, which is by no means the case ; and then the
original wound has to be enlarged. It is better to
make a sufficient opening at the start, and to close it at
the end of the operation by bringing the edges of the
wound together in the most delicate manner with the
finest possible silk, the ends of the suture being cut
off as close to the knot as possible. The opening should
not be greater, however, than two or two and a half
lines. 'J'his gentle closure of the wound produces no ■

inflammatory reaction, and the suture comes away of
itself, on aci'ount of its fineness, after a day or two,
almost unperceived.

We come now to the consideration of the later
improvement.^, which are in themselvi s of a good deal
of iiiifiortanoe, and often form, indeed, the principal
features in the operation. Tlic.>^e are the means which
Wf have in our power of increasing or diminishing the
effect of the tenotomy. This is done by the use of
8uture.«.

We will take first the suture which is employed to
increase the effect of the operation. The most effect-
ual one of which I am aware is that which was first
brought into general notice by Dr. Knapp a f w years
ago, though it had been in use in this country for some
time previous. The manner .ii which it is appied will
be better understood by a diagram, which we will
suppose represents a pair of eyes in which there is a
very pronounced squint of the right eye. say of 5 or
even G lines. We will suppose that the patient habi-
tually squints with this eye, and that tlie excursion
outw ards of this eye, though still good, is somewhat
limited, and can only be obtained to a full extent by
excessive convergence of the other eye. Under these
circumstances we have good reason to believe that the
exlernns, from being constantly on the stretch, has lost
some of its elasticity, and will not, by forcibly re-
tracting, draw the eye outwards after its antagoni.st
lias been cut. We will suppose that the internus hiis
been divided in the usual way, and that the effect from
the causes just mentioned is very small, so small indeed
that there is danger of the tendon reapplying itself at
or very near the seat of its original implantation. It
is manifest that we shall have gained little or nothing
by the operation, and it is under these circumstances
that the suture renders invaluable service.

Dr. Knapp's description of the method is as fol-
lows : — After a thorough tenotomy of the internus, a
small fold of the conjunctiva of one or two lines is picked
up close to the outer edge of the cornea, a curved needle
armed with pearl silk is pushed through it, and the
needle then carried through the external commissure
from within outwards, and the cornea made to ap-
proacli the outer angle of the eye to the required
amount by drawing on the suture, which is then tied
down upon the skin. By this means a fixed position
is obtained for an eye which otherwise would have a
tendency to turn in, during the time that the tendon is
gaining its new attachment, whieh latter, ,is the eye
is forcibly turned out, must lie further back than other-
wise would be the case, and the effect is consequently
much increa.sed.

I generally seek to obtain about a line of diver-
gence of the operated eye, immediately after the
operation. The suture should be left in one or even
two days. It very often comes away of itself on the
second day,

Graefe's method of increasing the effect of a teno-
tomy is as follows : — After the tenotomy of the internus
has been thoroughly performed, a fold of the conjunc-
tiva is lifted off from the episcleral tissue with the
forceps close to the outer canthus. A curved needle is
then run horizontally throuL'h this fold into the
subconjunctival space and made to glide (the forceps
being removed to the upper and inner border of the
cornea) beneath the membrane, till a portion of this
equal to three, four, or five lines lias been included,
when the point is again brought out, its place of exit
varying according to the length of its subconjunctival
passage, its direction being always from the commis-
sure to the upper and inner corneal border, or it may
be even to a point above the vertex of the cornea.

THE MEDICAL RECORD.

The suture i-i then tightly drawn and tied. By tliis
maiiceuvfe the eye is rolled outward.-; to the breadtli of
the enclosed tissue, and the limitation in the move-
ment of the eye inwards is much increased. In tliis
way Graefe says one is enabled to obtain, in excessive
degrees of convergent strabisinu-;, any correction de-
sirable. The suture must be left in at least two and a
half days.

Tiie suture is employCLl in preci?ely the same manner
in divergent strabismus, only it starts from the inner
cinthtis near the caruncle. Graefe says that this
method has been of signal service to him in the higher
grades of strabismus, and that since its adoption lie
has been far more reserved in the u^e of the advance-
ment of the muscle. Indeed he asserts that he scarce-
ly ever performs this latter now on account of diver-
gence, but only on account of marked limitation of the
mobility inwards.

Such being tiie means by which the effect of a te-
notomy is increased, those by wiiich the effect is
diminished remain to be spoken of. This is still done
by the use of the suture, and their mode of application
will be made clearer, 1 think, upon the board. We will
suppose that in a case of convergent squint we have
already divided the internus, and that the effect ob-
tained has been excessive, and that there is fear that
the eye will go the other way, or at lenst there Avill be
an insufficiency of converging power which may impair
the use of the eyes for any length of time upon close
object:*. Our object is to lessen the effect of the ori-
ginal tenotomy, and this is done by the suture, the
effect of which is graduated in the following ways :
If we have reason to believe that the eflfect of the
tenotomy is only a little more than that which we
wished originally to obtain, we simply bring the edges
of the wound together in a vertical direction ; this of
course prevents the muscle from retracting as far as it
otherwise would, and the effect of the operation is
somewhat limited. We can increase this again by
including more or less tissue within the stitch.
If we want to limit it to a greater degree, then, instead
of passing the needles vertically, we run them obliquel3' ;
this of course draws the muscle still more forward, and
the effect can be still further increased by including
more of the conjunctiva and subconjunctiva tissue
between the stitch. Or if, lastly, we wish to reduce
the efifect to a ver}^ considerable decree, we then pass
the needle in a directly horizontal direction, taking up
more or le-s of the tissue, according to circumstances.

It has been asserted with a good deal of force,
especially by Von Graefe, that the controlling influence
of these sutures is such that we can, if the operation
has been skilfully performed, invariably get any effect
whicii we may desire. While admitting to the fullest
extent their great u.sefulneps, and the very important
role they play in enabling us to increase and diminish
in a general way the effect of a tenotomy, candor com-
pels us to say that they have not in our own hands,
nor can we understand from the very nature of things
liow they can possibly act in anybody's with, that
mithematieal precision which the great master has
claimed for them.

I know of no absolute rules which can be laid down
as a guide either as to the immediate or permanent
eff.-ct of a tenotomy ; still there are three things, a
careful study of whicii should never be neglected.
F.rst, the condition of the externi and the extent of
motion outwards. Secondly, the refraction of the eye;
and thirdly, the eSict of the accommodation. If, for
example, the abduction of the eyes is limited, or only
obtained by a vacillating motion as soon a.s. or shortly
after, the squinting eye has passed the median Une, it ,

will be safe to predict that a greater setting back of ihe
muscle will be requited, and the effect of the o|)cration
will have to be increased by dividing both interni, —
when under ordinary circumstances we should divide
only one, — or, what is better, l)y the use of the suture.
And we may be sure of this even after, the patient
being thoroughly narcotized, we find, before we begin
the operation, a divergence of the eyes. I have been
so olten deceived by this amount of divergence wh< n
patients are under the .influence of an ^anajsthetic,
especially just after tlie muscle has been divided, that I
pay no attention to it when I have once convinced
my.vjelf that there is some weakness of the externi,
but base my calculation entirely on the examinations
made before the anajsthetic had been given — and this
(.■specially in regard to the suture.

Again we may put it down as a rule (but as a rule
that has many exceptions), that the greater the amount
of hyperraetropia, the greater amount of opeiating we
may do without the lear of obtaining too great an
effect. And here I Avould again insist upon the neces-
sity of reducing the eye — before resorting to repeated
operation — by the means of glasses, to as near a condi-
tion of a normal eye as possit)le.

Finally, if the eye swings in suddenly under the
influence of the accommodation, so that the squint is
disproportionately larger for the near than for the dis-
tance, we may assume that the energy of the externi is
reduced, and a greater freedom allowed in operating
than when the reverse is the case; that is to say, where
the squint neutralizes itself somewhat rapidly when we
approach an object towards the eye, so that at mode-
rate distances — twelve to sixteen inches — the two
eyi'S seem to be directed to the object. Starting then
with the assumption that in an ordinary ca=e of con-
comitant squint we get from two to three lines as the
efl'ect of an operation, the above rules may be of some
service in some of the commoner deviations from the
general run of cases. But for more than th's I should
not like to be responsible. I would not w-ish by this to
infer that I consider the operation of strabismus a work
of chance, for I sincerely believe that the more fully
w.' understand and the closer -we follow the optical and
dynamical laws which govern the condition under
consideration the more successful we shall be ; still I
cannot yet believe, however hopeful I may be for the
future, in that mathematical exactness which is at
present often claimed for it. The only rule which can
be conscientiously followed is to estimate by Careful
study as closely as we can the probable result, and then
to operate till success is obtained.

Some eight or ten hours after the operation, or when
the narcosis has passed entirely off, the patient should
be seen again, when anotiier examination should be
made, and this should be done as Graefe has shown,
not, as is usually the case, directly in front of the pa-
tient, that is, in the median line, but towards the tem-
poral side of the eye which has been operated on, the
object being at about fifteen feet from the patient and at
about 15° towards tlie temporal side. This, of course,
throws the strain off the divided muscle, and the in-
sufficiency which follows as the immediate effect of the
section is reduced, and a more correct estimate of what
will be the permanent effect is arrived at. Thus, if the
right internus has been divided, the patient should look
to the right.

I prefer, liowever, to make my examination in both
places, that is, directly in front, and then towards the
temporal side. As a rule, wdien, on seeing the patient,
I find that less effect has been obtained than was esti-
mated, I content myself with leaving things as they
are, preferring to operate on the other eye, using the

100

THE MEDICAL RECORD.

experience pained as to the eflect on the first eye as a
fjuiiie to the st-cond operation. But wla'iiever my es-
limatiim ol" the anla<;oiiistic force of tlie exteriii has
been so much out of llie way tliat very Httle or no ef-
Ici't has been produced, and the muscle is in danger of
reattacliinp itself at or very near tlie place of its orijji-
nal implantation, I never iiesitate to interfere ; and in
tliis ciu<:e I always use the suture described by Dr.
Kuapp, never that by Graefe — the eflect of which va-
ries, as lie himself allows, in every case accordinpf to
liie ditl'erent degrees of tlie elasticity of the coijuiutiva.
If tlie patient is an adult, and posses-sca a moderate
degree of nerve, an anieslhetic may be dispensed wi;h.
The wound can be reopened and the new and yielding
attachment*! reatlily severed with the strabismus hook.
In children it is better to always use an anaesthetic.

If, however, on the first visit after the opt-ration,
there is good reason to fear that too much ellect has
been obtained, the matter is much more serious, and
should be remedied as soon as possible. It is, however,
extremely ditficult to t,-ll, or at least to lay down any
exact rules by which it can be sately judged that too
much ellect has been obtained. Here it is that the
expetienced eye has so great an advantage, for any one
who has seen and studied a large number of cases can
olten tell at a glance that too much has been gained,
while it would puzzle liim to say exactly how he was
aware of it. Still the following method of examination
has been of service to me in a general way, and as
such I now offer it: —

If I find, twelve hours after the operation, that
there is a line of divergence when the patient looks at
an object, say at filteen feet, I look upon it not only as
no detriment, but a positive advantage for the perma-
nent eflect, provided the following conditions exist
with it : that the object can be gradually approached
towards the patient in the median line without the di-
vergence in the operated eye increasisig to any percep-
tible degree till the object gets inside of 12" or so. If,
on the contrary, the divergence gradually increases, or
even rema ns the same till within 10 or 12'' of the eye,
and then the eye suddenly flies out, or even begins to
waver, we have cause for apprehension, and the farther
that such a condition takes place from the eye, the
greater the dread. Acain, if we have a line or even
more of divergence in the median line for the distance,
and this disappears gradually as we carry the object
towards the temporal side of the eye operated upon,
till the" object lies 15' towards that side, we have Uttle
diead that the eflect is excessive, especially if, as is usu-
ally the case, the object can be carried close up to the
eves without the operated eye yielding.
" Should, however, the conditions of these two tests
not be fulfilled, it would be on the safe side to limit the
effect of the operations by the use of the suture, and
the quantity of the limitation should be graduated by
the degree of the divergence and the distance at which
it takes place. The proper amount, or its approxima-
tion, can, I think, only be learned by experience, to-
gether with a careful consideration as to the efl'eets to
be produced by the existing refraction and accommo-
dation.

The elal)orate rules laid down by Yon Graefe in re-
gard to dynamic squint, or insufficiency, are not, of
course, applicable here, as the requisite sharpness of
binocular vision very rarely if ever exists to make such
tests possible, much less trustworthy. The estimation
must be made by the operator's eye, not by means of
prisms.

The indications for the operation for strabismus are
rapidly becoming better known, so that many more
cas'.s come to operation in early life than formerly.

Still there is n lingering de>ire, especially on the part of
general practitioncr.s, to advi-e the parents to wait and
see if the child will not grow out of it, and to assert
that cross eye often gels well of itself; and if it does
not, it will be time enough to talk of an operation when
the child has reached lU or 12 years of age. Now it is
true that strabismus does sometimes disappear of itself,
but it is an exceedingly rare occurrence ; so rare, indeed,
a.s to be the exception neces.sary to prove the rule that
it does not cure itself; and that in the vast majority ol
eases recourse must be had to an operation. In regard
to this there is no division of opinion. But in regard
to the time of life at which the operation .should be per-
formed there is, I am sorry to say, much less unanimity,
and the general profes-ion have certainly the best of
exeusL's for the Fabian policy which they reconnnend on
the authority of some of the greatest writers on this
subject. Thus Bonders advises the use of " atropine in
young children upon whom it is as yet unadvisable to
operate." And Stellwag deliberately says that " it ia
better to postpone the operation till the beginning of
puberty, if the strabismus be seen in chil ihooJ. By
thus delaying, the conditions are fulfilled under which
periodical straljismus is removed, and the patient may,
as it were, grow out of a squint which has already be-
come permanent."

Notwithstanding the weight of such authority, I am
decidedly of the opinion that the cases in which the
operation should be deferred to a comparatively remote
period are few in proportion to those that should be
operated upon as soon as seen. And the chief points
which .>^hoidd influence our decision, either pro or con,
are as follows : — If the child is very young, say fiom
one to three years, and the squint is concomitant, so
that the excursion of the two eyes is equal, and at the
same time the squint is bilateral, so that the child fixes
sometimes with one eye and sometimes with the other,
it will be safe to postpone the operation almost indefi-
nitely, or so long as the conditions described hold good ;
for under this state of affairs the normal mobility of the
eye and the acuity of vision will be maintained ; and
this rule should be observed ail the more if there is
hypermetropia, for if this be of any considerable degree
the squint will most likely return after the operation, as
the age of the patient will prohibit the correction of the
optical defect by glasses.

But squint of this character is very rare in infants
and young children, as it usually results, not from an
optical defect, since the accommodation is not actively
employed, but from some paresis of the muscle?, so
that tlie squint is confined to one eye, and vision is
either entirely performed by the other, or so seldom by
the jqninting eye that this is practically excluded from
the visual act. If such eyes are left, to themselves, two
things almost invariably occur. 1st. The vision deteri-
orates, so that the ej'e in a short time becomes useless.
2d. The externus, from constantly being put upon the
stretch, loses its vitality, and the mobility of the eye
outwards is so reduced that the eye after a while gets
the appearance of being, if I may so express myself,
broadside on, producing, as the child grows up, a hide-
ous deformity, and one Avhich later in life requires al-
most an endless number of operations to remove. If,
on the other hand, we operate early, when ttie weak-
ened muscle still has a considerable share of its vitality
left, we can do no possible harm, and we stand the
chance of doing infinite good, either by cuiing the de-
formity at once, or at least of turning what was a uni-
lateral squint with exclusive use of one eye, into a
bilateral squint Avith the alternate use of the two
eyes, thus offering a much increased chance for the
preservation of the vision, and a much better prospect

THE MEDICAL RECORD.

01 <-^

of success from a future operation, when the muscles
sliall liave more fully recovered their tone. In these
cases it is almost always ncces>:ary to use the suture.

between the ages of 4 and 6 we begin to get the
common concomitant strabismus, dependent on either a
congenital defect, that is, hypermetropia, or, what
amounts lo the same thing, an imitation of this, through
the tempiirary reduction of the accommodative power b}^
some debilitating disease. In this latter condition, tiiat
i-, when the eye is emmetropic, or even slightly hyper-
metropic, I never hesitate to operate, liistly, with the
hope of restoring binocular vision ; and secondly, even
if this fails, of removing the deformity ; for if this is once
done there is little probability of its returning, since, as
there is very little or no defect in the refraction, there
is no exciting cause to occasion its return. After the
age of 7 or 8 years I alwavs operate, and insist, if the
error of refraction is sufiicient to warrant it, that glasses
must be worn.

Thus it will be seen, if these views are correct, that
the latitude of operative interference is largely in-
creased, at least in regard to the time of opeialing, in
comparison with what is usually held to be sound prac-
tice.

There is one other condition of squint in which the
general oi)inion seems to be adverse to operating, and
that is the strabismus of a paralytic nature occurring in
adults. This disinclination to operate in these cases evi-
dently had its origin in two sound objections. First,
an unwiUingness to subject the patient to the pain and
annoyance of an operation when his strabismus is either
accompanied by, or supposed to be the forerunner of,
grave central trouble. Secondly, from a conviction that
it was useless to operate on a muscle when the antan;-
onist of that muscle was either partially or wholly
paralyzed, as no effect would be gained. In regard to
the first of these objections, it is no doubt true that any
operative interference would be contra-indicated if cen-
tral trouble was shown to exist; but there are very
many cases in wdiich this does not manifest itself in the
slightest degree, either at the time of the attack or
later, or, even if it does in the beginning, fades away in
a short time, while the strabismus, with its annoying di-
plopia, remains. Under these conditions it seems to
me that the indications for an operation are as strong,
if not stronger, than in any other form of strabismus ;
and that they are so, I think will be more foi cibl3^and
more briefly shown by an example which is neither a
rare nor an imaginary one.

A man in the prime of life, after some exposure, or
an unusually hard day's work, or even after the or-
dinary routine of the day, goes to bed, as he thinks,
perfectly well, and is astonished on waking up in the
morning to find that he sees double. He immediately
consults his family physician, who at once sees where
the trouble lies, and, after a careful examination of his
general condition, pronounces it sound, prescribes rest,
absence from excitements and all abuses, whether of the
spirit or the flesh, and gives iodide of potash in increas-
ing doses. This maj^ or may not have some effect;
usually it does not, and then all the changes are run?
on the brom.ides, iodides, tonics, and electricity. Still
the double vision persists, and what at first was a sim-
ple annoyance now becomes an actual suflfering. There
is a constant dragging sensation about that side of the
head, with pain and tension in the forehead. The patient
begins to have a difficulty in getting about, or even at
times staggers or misses his footing. It is an exertion
for him to think, and he begins to fear that he is get-
ting light-headed, or that something is the matter with
his brain ; and it is in vain that his physician or an ex-
pert assures him to the contrary. To his suggestion.

that, as his eye is turned, benefit might be obtained,
from an operation, it is answered that, as his trouble is
of a paralytic nature, it would be worse than useless;
that things must be left to take their own course : and
if this advice is taken, the diplopia generally fades away
in a year or so, but the dragging, wearing, aching sen-
sations in or about the eye usually remain, either as a
constant companion, or to be called forth by the slight-
est over-exertion or excitement.

If, on the other hand, the patient, after a longer or
shorter interval, seeks the advice of the trained ophthal-
mologist, a minute examination is made, and I am
afraid, as the usual thing, precisely the same advice is
given, — exceptions to tiiis rul(>, though I am well
aware they do exist, being few and far between.
Sometimes, however, the oculist consulted, seeing that
very little harm can result, boldly makes up his mind
to run the chance of doing some good, and is often re-
warded for his courage either by the cure or relief of
his patient.

The second objection, that we get no effect from the
operation when the origin is a paralytic one, fades en-
tirely away, since, by the use of the suture or by
advancement of the muscle, we can get any effect we
desire, no matter what the cause of the strabismus is.

The treatment of paralytic strabismus is one of the
most difficult problems that the ophthalmic surgeon has
to deal with, and the dfterential diagnosis as to what
muscles are aftected in a given case, as laid down in the
books, and upon whicli we are made to believe our
opinions should rest, is a thing which may well appal
the boldest. So far as operating is concerned, the prac-
tical considerations necessary to determine our opinion,
at least in the majority of cases, can be reduced to a
comparative few. In the first place, the oblique
muscles, whether involved or not, are excluded, from the
positions of their insertions, from the category, tenoto-
ni}' of these muscles never having been, so far as I am
aware, followed by successful results. Nor am I per-
sonally aware of the attempt ever having been made to
cut these tendons, though I have heard traditionary
reports to that effect. This limits our attention to the
four recti muscles, and in the great majority of the cases
it is either the internus or externus which is chiefly af-
fected, and oftener the former than the latter. When
the superior and inferior are also implicated it is usually
in a secondary degree, and the deviation a trifling one.
When, then, a case of simple paralysis, either of the ex-
ternus or internus, presents itself, I do not hesitate to
operate, provided it is not marked by progressive dis-
ease of central origin, and provided sufficient time has
elapsed to show that therapeutical and hygienic means
wid not remove the trouble.

The only question, then, is, what operation we shall
do ; advancement of the paralyzed muscle with a teno-
tomy of the antagonist, or simply tenotomy of the op-
posing muscle and the use of the suture ? This depends
entirely on the degree of the trouble: if the paralysis
is complete and the motion towards the median fine is
very much limited, then resort must be had to advance-
ment of the paralyzed muscle, as laid down in the books.
But if the attack is slight, and rather a paresis than a
paralysis, or a paralysis improved into paresis, and there
is still some motion towards the median lino, then a
simple tenotomy with the suture will often produce, as
Graefe has pointed out, the most astonishing amount of
effect.

The fact of other muscles of the ocular group being
affected, as for example the superior or inferior rectus,
or even the obliques, used to be of great weight with
me in determining the propriety of an operation, for it
was argued that even if the horizontal double visicm

102

THE MEDICAL RECORD.

was removed the vertical would remain, and the diplo-
pia, tlioiifrh somewhal iliiTerent, would still be just as
annoyiiijr to tlie patient. But cxpei ienc has sliown me
that it is not ihe actual diplojiia whicli i:^ the ehii-f cause
of trouhle and annoyance to tlu-se patients, hut the
want of control they have over the eyes, and tlie subse-
quent dia<jginp and achinpr sensations ; and this is partic-
ularly noticeable when die strabismus is divergent. I
should not, therefore, unless the complications were ex-
tended and of a grave character, hesitate to operate to
remove the lateral strabismus, and let the vertical diplo-
pia take care of itself. I have known 15 or 20 degrees
of this to disappear shortly aft'-r the lateral deviation had
been corrected. But even if this cannot be corrected
by a second operation or by prisms, the double images
are usually sunk in the course of five or six n^onths, and
the patient passes from an improved condition from the
day of the operation, into what is ultimately a very
comfortable one.

As before remarked, very few of these cases come to
operation, and the great mistake which usually lakes
place in those that do, is that they are operated on too
late, when secondary contraction of the antagonist has
taken place and the weakened muscle has lost its vi-
tality ; and then an advancement has to be performed,
and not a tenotomy with the suture.

A short time after the paralytic attack there is gener-
ally an effort on the part of nature to re-establish the
co-ordinating movements of the eyes, provided the cause
is not a central one, and it is during this period that the
operation should be performed; and although cases vary,
and no rule can be laid down, it is usually best not to
wait longer than two months after the original at-
tack.

I would say in conclusion, Mr. President, that I am
rather unpleasantly conscious of the fact that the title
of my paper has proved to be a misnomer, for instead
of being, as I intended, a sketch of the operation for
strabismus, as it stands at present, it is only an outline
of a small part of it. Tliis has been caused by the vast-
ness of my subject, which has compelled me to leave out
mucli that I wished to write, and to discard much that I
had already written. And as itis, I cannot help expressing
the fear that my remarks have been both too extended
and of too simple a nature for the dignity of the rostrum
frdin which they have been delivered ; certainly they
have for the critical acumen of many of my hearers.
Still they are some of the points of practical importance
over which I myself have thought a great deal; and I
have believed that they might be of some use to those
of you whose practice brings you in contact with many
children, in answering the question so often put. Can
>trabismus be cured ? — a question which, though facts
do lend it some show of color, i.s, in the present advanced
state of medical art, neither very comphmentary to the
judgment of the general physician nor to the skill of the
oph th almologist.

Lead Poisonixg following the use of a " Hair Re-
newer."' — A case of complete paralysis of the e.xtensor
muscles of fingers and hands, with dropping of wrists,
is mentioned by J. M. Crocker, M.D., Proviucetown,
Mass., in the Boston Med. and Suvfj. Journal, produced
by the use of a " hair renewer." the preparation con-
sisted of three teaspoonfuls lac sulphur and two tea-
spoonfuls sugar of lea 1 to a pint of water. With this
he had drenched lii-; hair and sea!p as often as once a
week for 15 years. Under the use of iodide of potas-
siimi and galvanism the patient made a good recovery,
the hair-dressing having been discontinued.

CASES OF cs:rebro-spinal meningitis.

Bv CHARLES W. PACKARD, M.D..

NEW TOBK.

The following ca^es of Cerebro-Spinal Meningitis have
come under my professional care during the past few
weeks.

Annie C, aged .seven weeks, was taken wi'h vomit-
ing, restlessness, and fever at eleven p. m., on Saturday,
February 24th. On the afternoon of the following day
an eruption suddenly appeared, and the mother, beconi-
ing alarmed, brought the patient to my office.

I found the intiant collapsed, with a cool and pallid
surface ; pulsa slow and somewhat irregular, pupils
moderately dilated; and I learned that there had been
slight diarrhd-a, but no convul.-ions. The eruption was
roseolous in appearance, and ecchymotic. No diagnosis
was arrived at, although it was very evident that some
active blood-poison was at work. Difl'usible stimulants
were at once given, but without avail, the case tern)i-
nating fatally at one a.m. on the followinj; day, 26
hours after the first symptoms of illness were noticed.
Soon after death nearly the whole surface of the body
became discolored, and of a hue varying from i)urple
to dark-red. No autopsy.

On the afternoon of the same day, on returning from
the funeral of the infant, the parents found that their
onh' remaining child, a healthy boy three years of age,
was sick with headache, vomiting, and high lever. Ix.
was hoped that these symptoms might depend on tlic
fact that he had not slept the night before, owing to the
commotion in the room caused by the preparations for
the burial of the infant, and to his having eaten a large
amount of indigestible food during the day. There was
nothing di.scoverable in his physical condition that is
not constantly met with in the ephemeral fever ot
children.

On the following morning, February 27tb, the mother
called to inform me that he had passed a restless and
feverish night (I have since learned that he had three
undoubted convulsions), but that towards morning his
bowels acted freely, when his fever left him and he
slept quietly. On waking he seemed so playful and
well that the further services of a physician were not
considered necessary.

^ 4 P.M., twenty-four hours after the inception of the
disease, the father came in great haste to say, that after
having been lively and apparently well all day, the
child had suddenly met with " a change " and ap-
peared to be dying. I found him collapsed and in.-en-
sible, and apparently near death. The face and fore-
head were pallid and absolutely cold. Temperature in
axilla lul", pulse 84 and irregular, respiration 40 in
the minute. Pupils somewhat dilated and variable.
There were slight general convulsions at intervals of a
few minutes. No abduction of thumbs or toes, nor
rigidity of muscles; no eruption. Free stimulation
was at once resorted to, and in the course of halt
an hour a satisfactory reaction had begun. At this
stage of the case I invited my friend Dr. Samuel Whitall
to assist me in its observation and treatment. We at
once catheterized the patient and obtained a specimen
of urine which was normal in color and quantity and |
contained no albumen.

An eruption of petechial spots now suddenly ap-
peared on the body and extremities, being most abun-
dant on the neck and loins. The spots were of the
size of flea-bites, though of darker color, and some were
of a hnear shape, with fine radii upon one side, like the
feathers on a quill.

With returning warmth the nervous excitement be-

THE MEDICAL RECORD.

103

came intense. There were frequent shudderings, and
shiirt general convulsions, incoherence, witli occasional
shrill outcrifS that he was fahiug. At times the de-
lirium assumed a pleasant character for an instant, and
the child would smile and utter short sentences, in an
urgent, hurried way, such as "Mikey is a good boy,"
etc. ; there was persistent vomiting, and constant
movement of the trunk and extremities. The expres-
sion of the face indicated the e.vtreme gravity of the
disorder. The brow was corrugated, the eyelids of a
dusky red, looking just ready to become ecchymotic,
the nose was pinched, and the upper lip drawn, and
of a deathly pallor, in strong contrast to the brighter
color of the cheeks. The movements of the body were
unconstrained and natural, except that the head was
slightly thrown back.

In view of the almost maniacal condition of the
patient, it was thought advisable to begin the adminis-
tration of opium, which was given in increasing dose-^,
beginning with one drop of the tincture every hour;
the dose to be increased according to its effects. Hyd.
sub. mnr. gr. x. was placed upon the tongue. The
quieting effect of the opium soon became apparent.
The restlessness subsided, and the convulsions became
less and less frequent, and in two hours entirely ceased.
The pulse became perfectly regular, but rapidly in-
creased in frequency until in a few hours it had reached
160. Respiration 42 in the minute.

There was little change in the general condition of
the patient for the ensuing twenty-four hours, the dose
of tr. opii having been meanwhile gradually increased
to five drops an hour; but at the end of the second day
(forty-eight hours from attack) die violent and noisv ex-
citement returned, and witli it the vomiting. There
was subsultus and floccilation. The pupils were moder-
ately contracted, but sensible to light; slight strabismus.
No return of the convulsions. Xo new spots had ap-
peared, though a part of the eruption was of a darker
color than at first. The bowels had acted twice.
Urine no'w slightly albuminous. The patient became
comatose two hours before death, which took place
sixty-one hours after the attack.

An autopsy was made 30 hours after death, by Dr.
AVhitall and mj^self Cadaveric rigidity well marked.
On inspection the depending portions of the body were
found slightly discolored, and the eruption had assumed
a darker hue. Upon section the scalp was pale, and
no blood followed the knife. Dura mater injected ;
arachnoid intensely injected and dr}^ and underneath
it an abundant effusion of recent lymph of a gelatinous
consistency. This was found most noticeably along the
veins of the vertex, the longitudinal fissure, the fissure
of Sylvius, and there was also a slight deposit about
the optic commissure. Tf.e vessels of the medulla were
intensely injected, but no exudation had taken place.
Cerebral tissue somewhat injected, but of normal consis-
tency. Not more than 5j. of serum was found in the
ventricles. The conditions under which the autopsy
was secured rendered it impossible to extend the ex-
amination to the spinal cord and its membranes.

The following case occurred during my recent .ser-
vice in St. Luke's Ho-pital. I am indebted to the resi-
dent physician, Dr. Greo. D. Bleything, for the subjoined
history and careful record of daily temperatures: —

Annie Frazier, age 19, Eng., married, admitted
January 27th, 1872.

One week before admission was troubled with sore
throat, pain in the head, and constipation. The day
before admission had a severe chill lasting part of the
r.ight, and followed by fever and vomiting. On enter-
ing the hospital was suffering from .severe cephalalgia,
and great tenderness and pain in the post cervical region.

Some opisthotonos. There are large patches of her-

pes about the mouth and on the left hand. The limbs
are hypcrassthetic, but not swollen, and there is no im-
pairment of motion. No tenderness in abdomen, no
spnts on any part of body. The right eye seems slightly
deflected from a right line, and there is ptosis of right
lid. The tongue is vellow-coated, and the fauces red-
dened. Pulse is full and frequent, and bowels costive.
No abnormal sounds heard on auscultation. Is not at all
emaciated. Temp. 104°. Ordered Sp. Minder., | ss. ;
Sol. Magendie, git. vj. Jan. 28lh. — Slept well last
night, but is suffering greatly this morning. The ce-
phalalgia is increased, and tenderness of the muscles ia
the post-cervical region is very marked. Opisthotonos
more decided. There is some tenderness of muscles of
trunk and limbs, but no paralysis. Water is passed
without difficulty, bowels are costive, face is flushed,
pulse dichrotic. Temp. 105°. Ordered Tr. aconite rad.,
gtt. iij. ; Sp. Minder., ? ss. every three hours; sherry,
beef-tea, broth, and broken ice. Evening : More quiet,
continued treatment, and ordered enema. Jan. 29th,
symptoms continue with unabated force. Patient was
very nois}' and somewhat delirious through the night;
takes a fair amount of nourishment in fluid and semi-
fluid form ; calls constantly for ice. Temp. 104*; pulse,
130 and double. Stopped aconite, continued Sp. Mind,
and stimulants.

Jan. 30th. — Passed a bad night; was noisy and deli-
rious ; applied ice to head, but could not keep it on ;
vomited a green matter last night and this morning.
Tem. 104|° ; ordered Tr. aconite rad., gtt. v. ; and to take
Quin. sulph., gr. v.; Ac. sulph. dil., gtt. x., bis die;
whiskey, § vj. ; sherry stopped ; beef-tea, chicken, and
oyster broth ; egg beaten with sherry ; milk. Evening:
Temp, 104° ; ordered Sp. terebinth., ? ss. in enema, and
sinapism to back of neck.

Jan. 31. — Mind is clear, and headache somewhat less;
slept part of the night; still complains of the sub-occi-
pital pain, and also of frontal headache. Temp. 103";
took last night Tr. aconite rad., gtt. vij. ; Sp. Mind., ? ss.
every two hours ; stopped this morning and continued
quin., etc. Evening : Temp. 102i° ; ordered Pulv.
ipecac, cc, gr. x.

Feb. 1. — Face is flushed, and complains that whiskey
makes her head worse ; to be diminished to ? iv.
daily; quinine with iron. Temp., a.m., 102.2; p.m., 102.2.
Feb. 2. — Bowels have not moved sines last enema;
tongue is a little broAvn at centre, and white over sur-
face ; no spots or tenderness of abdomen ; no muscular
tenderness or opisthotonos; has lain on right side al-
most continually until now; this morning is lying on
leftside; there is still drooping of right lid, and heavy
I expression of face : slight impairment of hearing.
Old. enema, containing ol. ricini, r ss. ; temp. 101°.
I Evening, not so well ; complains of increased headache
i and cardialgia ; coughs, and expectorates a bloody and
I catarrhal matter, that apparently comes from posterior
' nares. There is some redness of fauces. Temp., p.m.,
! 104.2. Pulse is full and rapid. Auscultation gives neg-
ative results; stopped quin. and ordered sinapisms to
epigastrium ; to take tr. aconite and sp. Minder, as before.
Feb. 3. — Temp. 201.2. Is much better this morning;
stopped aconite ; continue stimulants. Evening, increa,se
of fever and headache. Temp. 106.2" ; renew aconite,
enema to move bowels; sinapism to feet; ice to head.
Feb. 4. — Temp., a.m.

Feb. 5
Feb. 6
Feb. 7
Feb. 8
Feb. 9
Feb. 10
Feb. 11
Feb. 12

103°;

P.M.

105

102.2

105

102

104.2

102

104.2

103.2

104

103 2

104

101.3

105

104

105

101

104

THE MEDICAL RECORD.

102^" ;

P.M.,

lO.-j^^

1(15

100

104

101

104

li4

103

104

Tliis inoniinjj voiiiitdl bieakfust, nnd is cou^'liiiip and
cxpecl oral ill},' oonsistuiit iiia-<.-i'«, resonibliiiR ralarrlial
liischarg.s, sliglitly ninrkfil wiih blood. Fauces no
lonj,'or leddciu'd, but pallid.

Feb. 1.3. — Vomited again this morning; other

symptoms are uncliangod, except that patimt had a

jirofuse sweat this morning. TLniji., a.m., 103°; p.m.,

104°.

Feb. 14— Temp., a.m , 102'
11 15

" IG "

" 17
II 18

II 19 II

" 20

" 21 "

Convalescence wa^ now fairly established, and the
patient left tlie ho.-spital Feb. 2Gtli apparently well. Her
appetite was good, and she slept soundly every night.
Tliere was considerable emaciation and general weak-
ness, such as would bo expected after so severe an ill-
ness, but no perverted sensation or paralysis.

Remarks. — The diagnosis of this ca-^e presented some
points of difficulty. In many respects the symptoms re-
sembled those met with in remittent fever occurring in
a person of strong hysterical tendencies. Throughout
the disease she had a tixed and placid expression of face,
an<l looked as if she would get well. On the other
hand, she had only one decided perspiration during her
s'ckness. and quinine in large doses had no effect in
checking the exacerbations of fever. For example, on
February loth, the morning temperature had fallen to
98' ; twenty grains of quinine were given and retained,
and the evening temperature rose to 105°. On the
following morning the temperature was 100° ; the
quinine was repeated, and the evening temperature was
104.^

After this no medication was attempted beyond the
exhibition of an opiate at, night when the patient was
very restless or delirious, the opium having been found
to act more efficiently than any of the ordinary substi-
tutes.

The quieting effect of opium was still more marked in
the case of the boy above leported. Here the tr. opii. was
given in five-drop doses every hour, and its effects
carefully watched. There is no doubt in my mind that
lor twenty-four hours it so far steadied the nervous
system as to stop the convulsion, and control the
irregular action of the pupils and of the heart. Full
n.ircotism was not produced at any time, the pupils
being only moderately contracted, and the respiration
never less than 30 in a minute.

205 E. SOtli Street, X. Y.

prooircss of illctiical Science.

CULOROFORM IS THE TREATMENT OF BiLIART CaLCULI.

— Dr. John Barclay, in a communication to the British
MeAlical Journal, mentions the case of a man who had
suffered for twenty-three years from gall-stones, and
knowing that ethers are solvents of cholesterine, he pre-
.scribed chloroform in doses of two or three drops three
or four times a day, on the chance of reaching the
calculi through the blood. The pain, tenderness, disten-
tion, and jaundice, all disappeared together, and in the
eight years which have since elapsed, the patient has
never had another attack.

AXTAGOSISM BETWEEN- CnLORAL AND CaLAB.\R BeAN.

In five experiments on as many rabbits, fatal doses of

the extract of ca'abar bean were injected hypodermi-
eully alter the lull effects of chloral w^re produced,
with a view to determine how far the poisonous inllu-
encc of the former wa.s counteracted by the latb-r. In
every case the convulsions were checked, and life pro-
longed, but death ultimately resulted.

Krperiinent G. Three-quarters of a grain of iho bean
extract injected killed a fulI-;jrown rabbit, with violent
general convulsions, in six minutes.

Krpcriment 7. Kepeated in a similar rabbit, after fif-
teen grains of chloral. No general convulsions, but
death occurred in two hoiirs and fifty-three minutes.

Krperiment 8. llepeated in a rabbit weighing si.x
pounds, alter fifteen grains of chloral. No general con-
vulsions, but in.senMbiliiy and profu.se salivation, paraly-
.'■is, ;md nmscular twitchings; death in one hour and
three-quarters.

Ej-perime)it 9. Repeated in a rabliit weighing six
pound-!. Same phenomena produced, lasting three and
one-quarter hours, when tlie animal slowly recovered.
Three-quarters of a grain of the extract of calabar bean
would probably kill any rabbit in from six to eight
minutes. The influence of chloral, in conteracting this
result, was most marked, as wdl be seen by the experi-
ments shown. — London Prartitioner.

Sulphate of Ikon in Suppuration. — A child, burned
all over, was lately brought into the hospital. The sup-
puration from the wounds was soprofiise and offensive,
that the ward, in which he lay, was almost uninhabita-
ble. He was placed in a bath containing two handlul.s
of sulphate of iron. The cessation of pain was almost
immediate; after repeating the bath twice a day, for
fifteen or twenty minutes at a time, the suppuration
moderated, the fetid odor disappeared, and the patient
rapidly recovered. — Boston Journal of C/iemistri/.

Arsenic in Dyspepsia. — Dr. J. C. Thorowgood, in
the Practitioner, speaks highly of the action of arsenic
in many diseases of the stomach. He has found that one-
drop doses of Fowler's solution inhalf an ounce of infu-
sion of Columba had the effect, in a case he treated, of
allaying the pain, stopping the vomiting of food, and
enabling the patient to eat and digest small quantities
of nmtton. lie states that the small irritable tongue,
with projecting papillie and yellow or gray fur, indicate
arsenic. The more purely local the gastric .symptoms,
the better is the chance of arsenic doing good. Where
there is much general exhaustion of the system, with
disordered urine or hepatic congestion, it does not
promise much.

New Treatment of HYnROOELE. — The Gazette Ilthio-
madaire contains a paper prepared by M. Monod, de-
scribing his method of treatincr hydrocele and other
serous accumulations, by injecting alcohol, either pure
or diluted. He first makes a puncture and draws off t
a drachm or more of the fluid, and then injects the'
alcohol. The operation is repeated, if necessary. By :
this method he succeeded in curing three cases of hy- j
drocele, and a serous cy.st of the neck resembling goitre,
the injection of a small quantity of a'cohol cau.-ing a I
rapid absorption of the entire fluid without inflamma-
tion and without requiring the patients to remain in |
bed. He suggests the same method for other serous |
accumulations. — Pacific Medical and Surgical Journal.

Dislocation and Fracture of Femur. — Dr. J. R.
Weist {Indiana Journal of Medicine) I'eports a case of
dislocation of the head of^ the femur upon the dorsum
ilii, in a lady fifty-seven j'ears of age, in Avhich he at-
tempted the reduction six months alter the injury. In

THE MEDICAL RECOHD.

105

the effort at reduction by manipulation, the neck of
the fi'inur was IVacturcd near the shnl't. The limb was
easiljr broii<rlit down on alino with the other, and when
left to itself wr.s only shortened from a half to throe
quarters of an inch. Q'he patient was placed in bed, and
tension made for six weeks by means of pulley, weight'*,
and adhesive straps. At the end of this time union
seemed to be suOiciently firm, and all dressings were
removed, and daily motion of tlie joint kept up. After
walking, shortening increased iVom a quarter of an inch
to an incli and a quarter. A year after the patient
could walk quite well without the aid of even a cane.
Nearly all the natural motions of the limb could be
executed external rotation and abduction being most
restricted. Tlie head of the femur remained in about the
position it was before the fracture.

SuLpnuRous Acid in SvPHrLiTic Ulceration. — Dr.
jSIurchison has recently tested this remedy at the Mid-
dlesex Hospital, with a favorable result, in the case of
an old woman, with tertiary syphilitic ulceration of the
pharynx, involving deeply the posterior pillars of the
fauces. Iodide of potassium with chlorate of potash
was employed internally, and the sulphurous acid (one
part to four of water) was used locally in the form of
spray. The ulceration was speedily checked, and con-
tinued to improve so long as the application was kept
up. When the treatment was omitted the ulceration
recommenced. — Richmond and Louisville Med. Jourivd.

Chloral Hydrate in Trismus Nascentium. — Dr. F.
Auchentha'er relates a case of trismus nascentium oc-
curring in a patient seven days old, and treated by chlo-
ral hydi-ate in doses of grs. vj. dissolved in mother's
milk. During the convulsions the medicine was carefully
instilled through the nostrils. Immediate benefit was
noticed, and in nine days the disease had entirely disap-
peared. During that time the child had experienced
twenty-seven paroxysms, and had taken twenty-five
grains of chloral. The temperature of the child's body,
duriufy the convulsion^, was seldom increased, and at
one time rose beyond 70^ C. — American Jvuriud of
Medical Sciences.

An Astringent in Gleet. — Dr. R. S. Johnson extols,
for cure of gleet, an astringent injection composed
of: IJ. Tr. opii, 3j. ; Tr. citechu, 3ss.; Mist, acacire,
3 ij. ; to be used twice daily. He relates one ca«e in
Nvhich the discharge ceased after the second application,
and did not return. — Medical Press and Circular.

On Simple Dislocation of the Os Innominata. — Mr.
C. Holthouse, of Westminster Hospital (The Prarfi-
tioner). reports two cases of this nature, which he has
recently met with in his practice, and gives the notes of
the only other cases, five in all, which had been previ-
ously published by other surgeons, in only three or four
of which had 'the injury been diagnosticated during the
life of the patient. Of the cases narrated, including liis
own, two were cnused by falls from a height, one by
heavy weights falling on the front of the pelvis, two
by pressure.'and tAVO by blows. In most of them the
displacement was upwards and backwards.

The only accidents with which this injury is likely to
be confounded are fractures of the pelvis, and of the cer-
vix femoris. The method of measuring the degree of
shortening from the iliac spine to the lower border of
the patella will exclude the latter ; the true character of
the injury being indicated by the mobility of one side of
the pelvis, and the absence of true bony crepitus. Five
of the cases reported recovered with more or less l.nming.
Mr. Holthouse considers a favorable prognosis warrant-
able, especially in the case of a young subject and when

uncomplicated. There seemed to be no reason why,
with moderate extension, manipulation, and a su'^taining
bandage, these cases might not have rccovcj-ed with
very little deformity.

Iodide of Starch Poultice for Slouohing Ulcers,
ETC. — Take two ounces of starch and mix with six
ounces of boiling water, to form a jelly ; then add, before
cold, half an ounce of tincture of iodine. The poultice
is now ready for use.

Modification of the Ordinary Tests for Biliary
Acids. — M. Strassburg, of Bremen, suggests a modifica-
tion of Pettenkofer's test for the presence of the bihary
acids in urine, which promises to be serviceable clinic-
ally, and, according to his statements, is of extreme
delicacy, enabling a trace not exceeding yin^noTT to be
readily detected. He dips a slip of filtering paper into
tlie urine suspected to contain the biliary acids, and to
which a little cane sugar has been previously added.
The slip is withdrawn and dried; a drop of pure, con-
centrated sulphuric acid is now applied to it by mean.s
of a glass rod. On holding the paper up to a strong
lidit, a beautiful violet color makes its appearance. —
Fiiiger's Archiv. The Practitioner.

A New Sedative. — Prof. Deneffe, of Ghent, states
that for more than two years he has employed a combi-
nation of camphor and bromine, which he thinks enti-
tled to general attention. The celebrated chemist Lau-
rent showed that bromine will easily unite with cam-
phor at ordinary temperatures, but that the product is
slowly decomposed by exposure to air. Prof. Schwartz,
of Ghent, has shown that this substance, being heated
in a closed vessel, is resolved into hydrobromic acid and
a crystallized compound, differing only from ordinary
camphor by the substitution of an atom of bromine for
an atom of hydrogen. This substance is perfectly crys-
tallizable, fusible at 7G^ C, and boiling at 274". In-
vestigation of the therapeutical properties of the drug
has shown it to be an excellent nervous sedative. Prof.
DenefFe publishes a case of excitement of the nervous
system, which was effectually relieved by it; seventy
grains may be made into thirty pills, of which one is
a dose, and may be repeated every hour, if occasion
requires. — Times and Gazette.

ScuRVY.^In the report in the Archives Generales de
Medecine, by Drs. Ch. Las^gue and A. Legroux, of the
epidemic of scurvy which took place in the prisons of
the Seine and the Hupital de la Pitie, in September, 1870
(during the siege), the curious fact is noted that in the
eighty-three cases which fell under their observation,
none of the patients were females, although the condi-
tions of privation were the same in the cases of both
sexes.

The Oxalate of Potash, in the treatment of perito-
nitis, is recommended in the Jour, de Med. et de C'hir.,
small doses in mucilage, repeated every hour, having
produced good results in three cases of puerperal origin.

Quinine and Digitalis in Hemicrania. — The same
journal states that i\IM. Df'bout and Gauchet have ob-
tained good results from this combination of remedies
in the treatment of vugraine, the formula employed
being, sulphate of quinine forty-six grains, powdeied di-
gitalis twenty-two grains, of syrup q. s., to be made into
thirty pills, of which one may be taken every evening.
Attacks connected with the menstrual period .«eem to
be most easily controlled by it. — The Practitioner.

Puncturation in the Treatment of Strangulated
Herma is spoken of by Dr. Autun, in the Gazette des
Hopitaux, several cases being mentioned by him in

106

THE MEDICAL RECORD.

which tin' cxtrnct ion of pas and air by the opernlion
rendetvd the rt-diiclion ol the hernia pns^ible. No bad
results occurred.

IlYDRorm.onATK of Amorphia. — The Ediuhnrg Medi-
cal Jourual tukcs from thi' Berliner Kliuisrhe Woclten-
schri/t the following dcsciiption uf a drnj,' about which
but iiltle is generally known. Sitbcrt, Ricgel, and
Bohmo have a.«certainp(i, by numerous experiments on
man and animals, that it is an ell'ectiial and active eme-
tic, aclinj:, aceordiiig to liohnie, in from four tosi.xteen
minutes, leaving behind it no unplea-ant efl'eets, and
possessing tlie important quidily that it can be cflectual-
ly introduced siiboutaneou.'^ly — a niatter of importance
in cliildren, insane, and comatose patient-J. Tlie unplea-
sant eflects have occasion:dly been giddines-!, cerebral
oppression, tendency to yawn, and precordial anxiety ;
and even tliese disappeared with the occurrence ol"
vomiting. No disagreable results on the digestive
organs were ever observed, and suppuration never took
place at tlie point of injection. The pliysiological effects
upon the pulse, temperature, and blood-pressure, were
found by Siebert to be of no practical importance. The
quantity necessary to produce emesis in man, when
u;:ed hypodermicaily, is 0.0925 to O.lOS gr. The mo.st
reliable pie[)aration is said by these observers to be
that of Macfarlau & Co., of Edinburg.

Similarity in the Clinical Appearancf:s of Ovari-
tis AND Typhoid Fever. — A writer in The Lancet of
February 24th .speaks of a case of the former afTection
under the care of Dr. Ramskill, in the London Hospital,
in which, for twenty days, tiiere had been a tempera-
ture ranging between 90.5' and 105'. There had, also,
been considerable dulness of intellect during tliis pe-
riod, together with marked tenderness in the x'v^hi iliac
region and consi-derable diarrhoea, the stools being very
like those characteristic of typhoid fever.

Ligation of the External Iliac Artery, high up in
the rigiit side, has recently been performed by Dr.
Butcher, of Dublin, in a man sixty-eight years old.
Thirty-five days after the operation the ligatures came
away, and b}' a fortnight later the wound was quite
healed, and the temperature and sensibility of tlie limb
restored, the aneurismal tumor having been reduced to
about the size of a billiard-ball, and become quite firm
and hard. The time occupied in the opei ation was nine
minutes, and the necessity for its performance was the
jires..'nce of an inguinal aneui ism, which was so large as
to extend above Poupart's ligament.

LiEBREicn ON Chloral Hydrate. — In the Gazette
Hehdumadaire for Dec. is an article by Prof. Liebreich.
in which the conditions of the use of chloral are laid
down more definitely than they have been heretofore.
All cases of insomnia without fever form the basisof its
application. For the relief of severe pain it cannot be
depended en without the addition of opiates. The
contraindications pointed out by Liebreich are as fol-
lows : —

\. Extended destruction of the mucous surfaces of the
prima vice. Here the remedy, if used, must be much
diluted with mucilage ; or it maybe thrown into the
rectum.

2. Arthritic conditions are unfavorable, unless the
blood be first rendered alkaline.

3. In tvphns, if given, it should be in small dose?.

4. In aflections of the circulatory apparatus, espe-
cially valvular and other serious troubles of the heart,
small doses should be used.

5. It is contraindicated in hysteria, in which it

often inerea.«e.H and fixes the condition of excitement,
whirh Prof. Liebreich considers inexpliealtle.

(i. Whether or not it is contraindiealed in icterus
remains doubtful, it having been so a.sserted.

The author goes on to say that it hhould never be
given in sulislanoe, nor in solution stronger than twenty
parts to a hundred.

It may be mixed with beer, wine, beef-tea, and mu-
cilage, lie prefers syrup of orange-peel. The so-called
syrups of chloral hydrate are solutions in glycerine with
sugar. Thin gruel may be employed ss a vehicle for an
enema. In certain convulsive attacks it may be applied
hypodermicaily. The cigarettes which have been pro-
posed are inadmissable. The best do.se for an adult is
irom thirty to forty-five grains. Habitual use does not
require increase of dose. "Long-continued use does
not impair the general health. I know persons who
have taken it almost since its introductiim, in the same
dose, and with the same success." — The Doctor.

[Dr. Squibb, of Brooklyn, .«ays thats<dutionsof chloral
hydrate with .syrup undergo decompo-it on int >, as yet,
unknown substances which are as likely to be poison-
ous as benign, and advises that if mixed with syrup it
should only be for immediate use. Cases have been
observed in which the loni,'-continued use of the reme-
dy has oicasioncd. it is thought, pains resembling those
of arthritic origin.]

Local Treat.ment of thk L'teru.s. — R, A, QuarlcF,
M.D., of St. Louis, Mo. (St. Louis Med. and Surf/.
Journal), in his Annual Report of the St. Louis Insti-
tute for the Tieatment of Diseases of Women, mentions
tliat tincture of iodine Cgr. 90 to Jj.) has been in almost
constant use in treating hypertrophies, chronic en-
gorgements, ca'arrhs and inflammations of the womb
and its lining membrane. Erosions of the os have
yielded most readily to a strong solution of nitrate of
silver. In almo.st all cases of uterine disease, warm
water vaginal injections were employed, medicated or
not, as the individual case required. For all cases of
vaginitis, whether specific or not, balsamum copaiba;
fnjection proved an unfailing remedy.

Thapsia as a Rubefacient and Revuisive. — The
action of this plant (one of the umbellifene) is very per-
sistent, differing, in this respect, from the ordinary rube-
facients. It may, therefore, be regarded not merely as
an accessory therapeutic agent, but as an independent
remedy to be used with advantage in many affection.':
of the vascular and nervous systems associated with
painful hyperassthesia. which it .«eems to remove in a
very noticeable manner. Dr. Armand has found its use
of preat service in inflammatory disea.ses of the chest
and of the larynx, when, in the latter, there was a con-
siderable amount of piping and whistling in respiration,
and great sensitiveness of the surface; and equally val-
uable in angina faucium. It may be used for children
as well as adult;. — AUgem. Wiener Med. Zeitung.

Pei-iosis Rheumatica. — Dr. W. A, Hardway, of St
Louis, Mo. (St. Louis Med. and Surg. Journ.), presents
a case of this quite uncommon affection, occurring in a
lad of 16, which exhibited features in common with
ordinary rheumatism, and might be taken for a case ol
that nature, the eiuption having been regarded as of
incidental occurrence. The fact, however, of the pete-
chias and the rheumatic pains being nearly always
coincident events, the absence of the elevated temper-
ature and more rapid pulse of acute rheumatism, to-
gether with the subsequent course of the disease,
clearly pointed out the distinction. Again, from the
J general malaise, the eruption, the pain.=;, peliosis rheu-

THE MEDICAL RECORD.

107

matica might be mistaken for an early syphilitic mani-
festation ; but the absoneo, after careful examination,
of any primary lesion, and of a venereal history, -would
settle tlie question satisfactorily.

TriK T'sis OF Pus in the x\nimal Economy. — Dr. A
P. Reid, of Halifax {Canmln Me'l JnnrnaJ), writes, in
regard to the use of jius in the anin:al economy, as fol-
lows : —

1st. It is the method by which dead exudation cor-
puscles and fluids assume a condition allowing of their
subsequent removal by a channel which is not ne-
cessarily injurious to the system at large, as they
would be if permitted to enter the blood, to be ex-
pelled by the enumctories.

2d. It is the method by whicli the before-mentioned
matters so collected together, when, from tavoring cir-
cumstances, tiiey cease to produce irritation in their
vicinity, are absorbed or removed by the emunctories;
the solid parts 6rst having undergone a fatty trans-
formation, owing to the influence exerted on them
by the free circulation of blood in the walls of the
ab-cess.

3d. It is the method by which dead exudatioh ma-
terial finally becomes incapsulated. The abscess ceas-
ing to produce inflammation in its vicinity, the free cir-
culation of blood in tlie abscess wall exerts such
changes in the composition of the fluid parts of the
pus as permit of their absorption without injury to
the health of the solid part, which cannot be so dealt
with, and which becomes inspissated in the form of in-
nocuous substances, such as f\it, phosphate of Ume, car-
bonate of lime, and other salts, united by an indeter-
minate animal matter.

4th. It is the method by which tissues of all kinds,
when deprived of their vitality, are reduced to a fluid
capable of easy removal ; as the contents of an abscess.

5th. It is the method adopted by Nature to assist
vital absorption in amputating dead tissues, either ex-
ternally or internally.

6th. It is the method which assists ulcerative absorp-
tion, so termed, in bringing an abscess to the surface;
one portion or side of the abscess wall becoming grad-
ually thinner as the abscess points.

Chloride of Zinc with Chloride of Potassium. — Or-
rlinary chloride of zinc is unsatisfactory as an escharotic,
because of its hygroscopic tendency." M. Bruns (phar-
macist) states this defect may be overcome by fusing
two parts of the chloride of zinc with one of the chlo-
ride of potassium, and casting in sticks which are to
be wrapped in tin foil.

Forced Delivery. — T. A. McKinney, M.D. (Leav.
Medical Herald), communicates an interesting case of
puerperal convulsions, with attending pneumonia,
showing the following points of interest: 1st. Forced
delivery is not unfrequently the only remedy for puer-
peral convul>ions. 2d. Delivery may be undertaken
after the seventh month without danger, when the os
is but very little dilated, though there may be no
signs of labor near. 3d. Pneumonia, caused possibly
by a poisoned state of the blood, may be a complication
of puerperal convulsions, though not always a fatal
one.

Treatment of Blennorrhagia. — Eleven cases of
blennorhagia are related by J. C. Van Wyck, M.D., of
Oakland, Cal. ( Western Lancet), in which treatment by
carbolic aciil, in combination with astringents and I
anodynes, was, he states, as near being a specific in
uncomplicated cases as any remedy believed to be
such in the domain of the materia medica. So firmly ,

is he convinced that to it alone are to be attributed the
gratifying results which have marked every case in
which it was employed, that with the next patient who
comes under his care he will use the remedy simply
diluted with distilled water.

The Use of Alcohol in Chronic OtorrhovA. — A. "W.
Calhoun, M.D., now of Berlin, Prussia ( fi^eorr/Za ^[ed.
Comp.), having been sceptical in regard to the benefi-
cial use of puie undiluted alcohol for the cure of un-
complicated chronic purulent otitis, or otorrhoea, as
practised in the clinic of Dr. Weber, one of the editors
of the Monatschrift fur (jlirenheilkunde, writes that he
has been enabled to follow a number of cases, as they
progressed under this treatment, from the date of
their first entrance into the Clinic till their dis-
charge as cured — and is now thoroughly satisfied of
its eflicacy, having seen cases of eight and ten years'
standing, with destruction of membrana tympani, cured
in comparatively short time. The application of undi-
luted alcohol does not produce intense pain ; for a few
moments there is a smarting, slightly burning feeling,
which gives place to a sensation described by patients
as that of an " agreeable warmth." This latter lasts
for a considerable time.

T^NiA Solium and Taenia Lata in a Child Three
Years Old. — A case of this character, occurring in a boy
three years and four months old, is reported by Dr.
Joseph Ganghofer, in the Kansas City Medical Journal.
The child had excessive craving for carrots, of Avhich
he would daily consume large quantities, both cooked
and raw. After persisting in this unnatural appetite
for six weeks, a toenia solium of about eleven feet in
length was passed. The morbid appetite of the patient
still continued, and, on account of the largely distended
abdomen, the carrot treatment was advised. Within
two weeks another worm was passed ; this time a
tccnia lata ten feet long, which came away entire, in-
clusive of the head.

Dr. Ganghofer remarks that the use of carrots as a
domestic anthelmintic in cases of ascarides and lum-
brici is no novelty, but their eiBcacy in dislodging the
diflerent varieties of tape-worm has never before been
established. It would appear that the large amount of
saccharine matter contained in the vegetable must have
sickened the parasite, and thus have caused its detach-
ment from the walls of the intestine.

Treatjient of Cystitis and Irritable Bladder of
Females.— M. Yarnall, M.D., St. Louis, Mo. (The Med.
Archives), calls attention to a treatment for cystitis and
irritable bladder of females, practised by Dr. T. L.
Papin, which has afforded such excellent results. This
treatment, which is original with Dr. Papin, consists
in dilating tlie urethra with a long pair of dressing
forceps to such an extent as to produce temporary in-
continence of urine by rupturing a few of the fibres of
the sphincter of the bladder ; and repeating the operation,
when necessary, at intervals of a week or more, until the
patient is completely relieved. In nearly every in-
stance the relief afforded is almost immediate, but in
the course of a few days the irritabihty of the bladder
ussually returns, M'hen the operation has to be repeated,
and, if necessary, again repeated, until a cure is ac-
complished.

The operation being at first very painful, it will usu-
ally be found necessary, in performing it the first time,
to place the patient under the influence of an anaes-
thetic; but its subsequent performance being much less
severe, as a rule, the anaesthetic will be unnecessary
unless the patient be of a very nervous temperament.
Of the twenty cases thus far treated, eleven have been

108

THE MEDICAL RECORD.

entirely relieveJ, nml eight, still umler Ireatinent, have
been bcnolited, •vvitli a pro-pect of pcriiiftiient relief. In
onlv one case has it failed, a very hysti-rieal individual
addicted to the excessive use of nareotfics, and with
whom the trouble oiipinatcd, piobably, in the over-
wroujijlit mental condition of the patient rather than
the ve.-ical irritation; and even here the patient was
unquestionably benefited.

Rabies. — 'SI. Auzias Turenne endeavors to establish a
parallel between the pheiiomcna of rabiis and those of
syphilis. It will be remembered that Marochetti con-
sidered that the virus, after having btea absorbed by
the wound, enters the circulation and tlun gaiiicrs
under the tongue. From the third to the ninth day,
small vesicles containing tlie virus appear on each side
of the fr«num Iingu;v, and are called ly.^sa*. lie believes
that by cauterizing these vesicles the further progress of
the disease would be prevented. Experience has not
confirmed these views, but M. Turenne, starting from
the phenomena, has attempted to liken rabies to sy-
philid, and the ly?s;c to the infecting chancre. — Do-
minion ^fe^Ucal Journal.

CoNSTiPATio.v. — Dr. Henry Field strongly recom-
mends the arsenite of iion in the constipation attending
uterine disease. Oxalate of iron is also recommended.

Bromide of Potassitm in WnoopixG-corcn. — Dr.
Beaufort uses the bromide with syr. of Tolu and an
alcoholic preparation of aconite, combined together, and
by the aid ot these three remedies he has seen the dis-
ease cured in an average of twelve days.

Citric Acid in After-Pains. — Dr. J. B. Chagnon
{CanaiJa }fedical Journal) has used citric acid in jtartu-
rient women with the most happy results. It not only
acts as a nervine (?). but also as the best, prophylactic
a'zainsi inflammations, such a? metritis, peritonitis, etc.
He gives it to relieve after-pains in the doses of five
grains in a wine-glass of water every five hours.

TixcTURE OF Gelsemum IN Tetancs. — In the Balii-
Tiiore Meiliral Journal is recorded a recovery from teta-
nus, for which gelsemium was administered. Tlie disease
1 isted seventeen days, during which time twenty ounces
of the tincture were taken. During the first twelve
days the patient took from half a drachm to two
drachms every hour.

Injury of the Eye. — Dr. II. M. Sogie {Ohio Medical
and Suriiical Reporter) reports the following case, which
occurred in his practice : A man was blown out of a
mill by the explosion of a boiler. He received, along
with other injuries, a wound over the supra-orbital arch.
The iris was seen to be detached at i;s upper border for
about one-fifth of its circumference, and it hung down
near the middle of the lens, which was not detached
from its place. There was but little hemorrhage, and
but slight iritis followed the accident. After the patient
had recovered from the other injuries (fracture of both
limbsj the sight remained unimpaired, except in so far
as it was interfered with by the inal-position of the iris.

On the Growth of the Nails as a Means of Progno-
sis IN Cerebral Paralysis.— Dr. S. W. Mitcliel {Arner-
ican Journal of Medical Sciences) states that he has ob-
served in several cases of paralysis that the nails of the
limbs of the aflected side, on the occurrence of the
accident, ceased to grow. This was proved by staining
the roots of the nails with nitric acid. He was able to
predict, in .seeing after a time a white line of nail mak-
ing its appearance, and before there Avere any other signs

of imjtroveinint, that jiower was about to return to the
limit, and that voluntary motion would s-horlly be
restored.

AiiSENCE OF A Lung. — Dr. W. Dickey communicates
to the Civrinnati Lancet and Observer an extremely in-
teresting history of a ca.se which had been under his
care, and concludes by giving the following accmint of
the autopsy, made twelve h(jurs afier death. Tlie left
lung was found studded with tubercles, and was eome-
what larger than usual, but consisted of two lobts. Un
the right side there was no lung at all, not even a
rudiment nt the bil'urcation. Ko lung had ever existed.
Heart in the mediastinal .space, but in the rifjht side,
corresponding to a natural situation in the left. Its
walls were thickened, and cavities somewhat enlarged.

Manual Force to tue Uterus as an Adjuvant in
Labor. — Dr. J. H. Grant (Xew Orleans Journal nf Medi-
ciue) advocates the application of physical force to the
fundus uteri during laiior, and gives the histories of five
cases, where it was applied with most manifest influence
for good in hastening the birth of the child. His Jtlan
is to bpply both hands over the fundus uteri, and exert
the force in the longitudinal diameter. In some of these
cases the strength of one assistant not being deemed
sufficient, the hands of a second person were spread
over those of the first, and their united cfi'orts produced
the happiest results. Where the pains were insuflficient,
the physical pressure served to increase them, thus "ob-
viating the use of forceps and turning, except in cases
of malposition of the foetus."

Efficacy of Large Draughts of Water in Poison-
ing. — The Xew Orleans Journal of Medicine contains the
history of a case of poisoning by corrosive sublimate.
The patient had taken a large dose of the poison. The
lips and mouih were much swollen; there were violent
pain and burning heat in the stomach, and he was ex-
tremely ill. He Wiis ordered to drink at intervals, but
as speedil}' as possible, twelve pints of warm water,
and that as often as he should vomit he should drink
more. As soon as, by the pains, it w-as perceived the
poison had entered the bow^els, the patient was ordered
large injections of simply tepid water. The first eva-
cuations of the stomach were extremely acrid, on tic-
count of the quantity of the poison which they contain-
ed ; subsequent ones were less and less acrid with each
evacuation, until they became completely free. The
colics which came on were treated by fresh clysters.
These simple means were so successful that in a few
hours the patient was out of danger.

Case of Tetanus Cpred by Excision of a Nerve.-
Dr. George E. Foster {Boston Medical and Surrjical
Journal) communicates a case of tetanus, following a
Avound made by a shoe-nail entering the heel. The
wound healed, leaving no trace of the injury. About
three weeks after, the patient was aAvakened in the night
with chills, stiffness of the limbs, and sliuht tAvilching
of the muscles of the arm. He was given all the suit-
able medicines, but with no effect to mitigate the symp-
toms. It was then decided to cut down and remove a
portion of the internal plantar nerve, which was done
with the effect of entirely relieving the spasms. The
patient afterwards had a complete recovery.

GossYPiuM AS AN Anodyne. — Dr. Robert E. Peyton'
(Richmond a)td LonisviVe Med. Journ.), relates a dis-
tressing case of phthisis pulmonalis, in which, after
giving other remedies unsatisfactorily, teaspoonful doses
of the fluid extract of cotton-root gave the patient''
much relief.

THE MEDICAL RECOi«D\

109

The Medical Record:

A SEMI-MONTHLY JOURNAL OF MEDICINE
AND SURGERY.

GEORGE F. SHRADY, A.M., M.D., Editor.

PubliJilied (»i the 1st and 15tk of each Month by
TVilI. ^VOO» & CO., 27 Great Jones Street, IV. Y.

New ^^orls, April 15, 1873.

HOSPITAL APPOINTMENTS.

It has become so much the fashion in making hos-
pital appointments to allow almost every consideration
save professional ability to influence the appointing
power, that the prospect of reform seems an almost
liopeless one. "VVe are so firmly convinced, however,
that there must be some remedy for the evils connect-
ed with the practice, that we are determined to make
every effort to discover it. We are perfectly aware of
the fact that every applicant for a position in the hos-
pital cannot expect to be successful, but, in view of the
large numbtu- of capaljle men who do apply, we have a
right to, complain when the selections are not extiaordi-
narily good ones.

^ i'rom present indications there appears to be no jios-
'^sible excuse for the ordinarj^ and generally accepted
method of filling the professional positions in our large
hospitals save partizansliip, or gross favoritism. Since
our last remarks upon this subject, three liospitals have
sprung into existence in our midst, the positions in all of
which have been duly filled. No one acquainted with
the requisites for oblaining such 'appointments is sur-
prised at the hst of the attending physicians and sur-
geons. The reasons why such and such men hold such
positions are very easily explained. Here, for instance,
is a college which must have nearly every member of
its faculty in a hospital position, and when each mem-
ber of said faculty who desires such an appointment is
satisfied, it so happens that there are no places for any
one else. The appointing power of another hospital is
given to a single medical gentleman, and if he is con-
nected with any pai-ticular school, as he is most sure to
be, so much the better for the school. If he has friends
or relatives whom he wishes to advance, no one seems
to question his right to find positions for them not only
in the hospital, but in the college — in fact, in the interests
of the school he represents, both appointments must go

together. In a hospital in which all the schools have
a right to be represented, there are many tricks ])layed,
and many subterfuges resorted to in order to have a
majority representation, which, if the said manoeuvres
were not made by some of our leading teachers, Ave
should be privileged in calling them unprofessional,
disgraceful, and ungentlemanly.

We are perfectly willing that clinical teachers should
hold hospital positions, in fact it is veiy necessary that
they should ; but we claim that all the clinical teachers
are not in our colleges. We fail to see how any col-
lege, because it chooses to elect any one professor,
can insist that such a gentleman must necessarily be a
clinical teacher, and must, as a matter of course, hold a
hospital appointment. Instead of colleges making
clinical teachers, the clinical teachers should make the
colleges. Many of the best clinical teachers we have
seen, never held any chair in our college faculties, and
we have a good reason for supposing that there are
many more of the same S)rt who could use a hospital
position to equally good advantage, if the colleges
would graciously allow tliem the chance. If the col-
leges would sometimes stop to consider how many
good chnical teachers they might obtain by allowing
an occasional outsider to hold a hospital position, and
prove himself, by his work alone, worthy of a position
as professor, we should have more men created for
places, than places created for men. We are interested
in the prosperity of the colleges, but the colleges
cannot reasonably be expected to mean the profession.
A gentleman who may have quietly devoted himself to
his profession, who may have worked faithfully in a
dispensary, and m;iy have a peculiar fitness for hospi-
tal work and for clinical teaching, and who may be a
thoroughly practical man, may perchance be of as
much service in a public institution as if he Avere
connected with some college. If we are mistaken in
this, and if our colleges contain all the good and capa-
ble medical men, we are forced to the huinihatmg-
confession that by far the largest majority of the so-
called profession are good for nothing. If we allow
the colleges to monopolize all the hospital appoint-
ments, and tacitly acknowledge their right to dictate to
such as are unfortunate enough to be mere practitioners,
we cannot escape the legii;imate conclusion that the pro-
fession have no rights whatever in the matter. This
is in fact quite evident from the appointments recently
made in the hospitals named.

We are emphatically opposed to all party influences
in making these appointments, and believe that every
man who applies for a position should have his claims
impartially considered. We care not whether he be a
professor or a " possessor," or both ; we, in the interests
of the profession at large, call for fair play. When a
hospital staff is to be selected, let the fact be duly ad-
vertised ; let each applicant for the place present his
credentials and his claims, and let these alone be the
bases upon which his position is secured. Why is it

TlIK MEDICAL RECORD.

necessary to keep the fact that appointments are to be
mnde so quiet ? Why is it neccsi:nry to keep every one
who might be imhiced to apply, in ipnorancc until all the
places nri' fillid? Wliy is this done, if not with the
avowed object of nionojiolizing honorable po-itionsand
stifling legitimate endeavor?

On a future occasion we shall present some of the de-
tails by wliicli hospital appointments are secured to the
select few. If any of our readers have any facts to
communicate bearing upon tliis point, we shall use
them in such a way as shall lend to promote the best
interests of the profession, and the greatest good to
our public institutions. Our .^ole aim shall be to venti-
late the subject with a view to reform and to reform
only, entirely independent of every other consideration
but simple justice. We believe that this and a great
many other matters connected with our hospital man-
agement need looking into, and we are ready and will-
ing to discuss them.

AMERICAN MEDICAL ASSOCIATIO.V.

The ne.\t meeting of the Anr.erican Medical Associa-
tion, to be held in Philadelphia, promises to be unu-
su dly interesting. It is the determination of the Com-
mittee of Arrangements for that city to contribute in
every possible way to the comfort and edification of
the delegates. Tiiere is no doubt that there will be a
very full attendance. New York will, we are assured,
be particularly well represented. It is to be hoped that
the meeting will be a harmonious one, and that those
who attend will be spared the discu.^sion of several of
the vexed and useless questions which have occupied
so much time during the last few sessions. In another
column we publish some details regarding arrange-
ments made with the railroads for excursion tickets,
etc.

Ucuicius aiit) notices of Oooks.

Lectures ox the Clinicat, Uses of Electricity. By
J. Russell Reynolds, M.D. Philadelphia : Lmdsay
& Blakiston. 1872.

Electricity ix its Relations to Practical Medi-
crxE. By Dr. Morttz JIeyer. Secoud revised and
American edition. Translated bv Wm. A. ILv.MMOND,
>LD. New York: 1872. D. Appleton & Co.

Dr. Reyn: lds is one of the ablest and most cultivated
physicians of London. On nearly all subjects of genei al
medicine he writes sensibly and clearly, and to electro-
therapeutics he has given mo-e attention than the
inajority of even the most advanced practitioners.

Tliis little work is perhaps all that it professes to be —
a clear and suctimt statement, in language to suit
the mind of the beginner, of some of the elementary
princip'es of localized electric'Stn. So far as it goes
— which is not very far — it is unusually clear. Its
srrong meris are lucidness and common sense. Its
omissions are, of course, enormous ; it gives but the
alphabet of electro-theraj>eutics : the author is, to say
the least, ten years behi::d the time; and yet very few

writers on general medicine is as well advjtnceil in
electro-tlicraiieuticii as he. He does not filly compre-
hend tlie po.sition of electricity in the maii-ria medica,
but he comes nearer to tiie truth than most writ<T8 on
the subject. He does not mention the majority of the
disea.ses in which it is most succi-ssful. His experience,
though intelligent, is evidently limited and narrow. To
depend on such manuals for our knowledge of electro-
therapeutics would be a most serious mistake.

Elementary lectures of this kind are more needed in
London than almost anywhere else, for it is true, as
Prof Huxley say->, that, excepting in political economy
and geology, English scientists are behindhand in
science. 8ave Altiiaus and a very few others, the
London physicians, as were shown by a recent contro-
versy, in the meiiical journals, between Dr.«. Gull and
Ansiie, are only just beginning to open their eyes to
the subject of electro-therapeutics. In no other great
medical centre would the adverse opinion even of so
high an authority as Dr. Gull have been thought wor-
thy of a moment's consideration from any intelligent
human being.

There are three points in this work of Dr. Reynolds,
that are of themselves worth the price of the book,
especially for those who blindly follow in the wake of
Diichenne and Remak. These points are: —

1. The differential action of the currents of the pri-
mary and the secondary coil.

2. The difl'erential action of the two currents.

3. The differential action of the ascending and de-
scending currents.

There are now in this country a very large number
of physicians, young and old, who are diligently in-
vestigating the subject of electro-therapeutics, and who
would do well to obtain this little work of Dr. Rey-
nolds, imperfect as it is, and to study it in connection
with other text books of the subject, chiefly as a com-
pliment to its clearness, fairness, and good sense. It
is safe to assert that at the present time there is more
doing in electro-therapeutics in the United States, both
in the way of original research and in the way of popu-
larization than in Great Britain or France or Germany.
Like surgery, it has become an American science. All the
American apparatus for medical and suri.'ical electricity
are equd to, and very often incomparably superior to,
those of European manufacture. If we are to maintain
this advanced position, we should inpartially and care-
fully avail ourselves of the best fruits of modern research
in every direction. It is necessary to sow beside all
waters. There is no book on electro-therapeutics so
poor but that it may teach us something of real value, or
at least give us suggestions by means of which we may
be enabled to pursue our investigations w^ith "reater
intelligence and success. Every* publication on the
subj'Ct, therefore, is to be welcomed.

The work of Meyer is now well known, and both its
merits and demerits have been publicly recognized.
Very far inferior to the work of Benedikt in strengtii
and suggestiveness. it is perhaps better adapted to meet
the general want. It gives a fair and truthful rC'Sume
of the state of medical and surgical electricity, so far as
we know, in Europe, at the time of publication. It is
now of necessity considerably behind the times, though
much in advance of Reynolds. Meyer is utterly free
from hobbies, and evidently has no prejudices. His style,
however, is more German than English ; his directions
are oftentimes obscure, and in generalizing power he is
greatly deficient. His want of diagnostic skill impairs
seriously the value of some of the cases reported.
Case 84. reported on page 396, as a case of locomotor
ataxia, is really not locomotor ataxia at all. The
pathological condition was probably a local and tempo-

THE MEDICAL RECORD.

Ill

rary congestion of the cord— a condition which, when
neglected, ni;iy in perhaps one c;ise out of a hunch-ed or
tliousand, go on to be sclerosis of the posterior columns.

We speak particularly of this case, because it will
mislead those who are trying to cure locomotor ataxia
by electri.nty. After the process of degeneration of the
cord has really set in, galvanization very rarely cures,
though it may relieve.

The editorlias in this edition corrected several of the
typographical errors of the first edition, and has called
attention to the very excellent apparatus of the Galvano-
Faradic Mfi,^ Co.

In closing these brief notices, we may remark that no
one who wants to keep abreast of the times in electro-
therapeutic-? should depend on text-books, even the best
and mo<t recent. The medical journals first herald the
glad tidings of electro-tlnrapeutic experiment and dis-
cover}', and one of the German year-books has a s-epa-
rate department devoted to electro-therapeutic?, in
which every article on the subject of any importance,
published in any language, receives proper credit.

Hcports of Societies.

NEW YORK PATHOLOGICAL SOCIETY.

Slated Meeting, Fehruary 14, 1872.
Dr. a. L. Loomis, President, in the Chair.

ANOMALOUS MALFORMATION OF THE HEART.

Dr. Mary C. Putnam presented a case of congenital
malfurmation of the heart, taken from a child wlio died
anntng the patients of the out-practiee of the N. Y. In-
firmary.

The child was born at term, of perfectly healthy pa-
rents, and for a week appeared to be quite vigorous, it
having never presented tlie slightest trace of cyanosis.
No examination had ever been made of the prtecordium
for heart-nmrmurs, as no cardiac symptom had been
presented, when, on the eighth day after birth, the child
seemed attacked Avith viulent pain in the chest, and
screamed for several hours. It then fell into a semi-
comatose condition, which grailually deepened until
death. This supervened about twelve hours from the
commencement of the attack. It was seen by no phy-
sician during this short illness.

At the autopsy, the immediate cause of death was
found in an extensive congestion of the lungs, which
occupied them entirely, witli the exception of a small
point at each apex. The lungs floated in water.

The brain presented the congestion characteristic of
asphyxia, and the same deep-blue congestion was no-
ticeable in the corunary veins of the heart. The original
lesion existed in this organ. Externally it was round-
ed and quadrangular, resembling the turtle's heart — a
resemblance that h;is often been noticed in eases where
a communication existed between the two ventricles.
No sucli communication was present, however, in this
case. The left ventricle was immensely hypertrophied
anil dilated, constituting the body of the heart.

Contrary to expectation, as based upon the tnrgid
condition of the coronary veins, this ventricle contained
hardly any blood. The mitral valve was normal; the
aorta opened into the ventricle as usual, and its orifice
was also normal.

The septum between the two ventricles — that in the
large majority of cases of malformation is deviated to
the left — was deviated to the right, and was indicated

on the external surface by a broad fibrous line sloping
oblicpiely from the base of the heart to the right side,
and cutting o(f a small segment at the upper right
angle. This segment represented the right ventii'-le,
whose cavity had been almost entirely obliterated by
concentric hypertrophy of its wall-;, which seemed to
Ibrm part of the septum ventriculorum. A shallow
depression just below the tricuspid valve was all that
remained of the cavity. The tricuspid valve was very
imperfect, constituted by a single membrane, supported
at each extremity by a group of rudimentary cordal
tendinsc.

The pulmonary artery wis placed immediately upon
the septum. It had, therefore, no communication with
either ventricle, but terminaied in a cul-de-sac closed
by muscular fibre. At the extremity of this cul-de-sac
might be discerned two rudimentary lossje that indi-
cated the place of two sigmoid valves, but no trace of
the v.-ilves tliemselves existed.

Above this point the pulmonary artery was perme-
able throughout, although its diameter was about a
third less than that of the aorta. The ductus arteriosus
was quite permeable.

The auricles were both large. The foramen ovale
was open, but the valve well developed. The Eustachian
valve persisted, and it was evident that the blood from
the inferior cava liad never passed into the right ven-
tricle, but had always been thrown immediately into the
left auricle. The potency of the foramen ovale ami of
the ductus arteriosus sufficiently explained the circula-
tion. All the blood passed into the lelt ventricle and
thence into the aorta, and, by means of the ductu'^, the
necessary supply was sent to the lungs, not only for
their nutrition, but, during life, for the function of respi-
ration. The heart, therefore, was really composed of
only three cavities, a ventricle and two auricles, and
this is one of the rarest forms of cardiac monstrosity.
The obUteration of the pulmonary aorta which also ex-
isted was only an epiphenomenon of the general lesion.
Stricture of the pulmonary oiifice is the most common
of all kinds of foetal lesions; this orifice being afiected
in 99 out of 153 cases given by Peacock. As is well
known, Rokitansky first called attention to the frequency
of lesions of the pulmonary artery in foetal life, as com-
pared with the almost equal exclusiveness of aortic
disease after the estabhshment of extra-uterine circula-
tion. The explanation given by Peacock of this fact
is very plausible, that during foetal life the pulmonary
orifice sustains the shock of all the inequalities of pres-
sure in the circulation of the placenta and of the um-
bilical arteries. He suggests that such variations of
piessure may themselves account for the localized endo-
carditis and endoarterilis which Rokitansky poinjed out,
and upon Avhich Meyer (ArcJiiv der Virch. 1857) has
particularly insisted.

In cases of pulmonary stricture from such cause, the
light ventricle is hypertrophied. If, as is generally the
case, the Usion occurs before the closure of the se[)tum —
that is, before the end of the second month — an orifice
of communication remains betv/een the two ventricles,
as the blood is forced through this opening more easily
than into the artery. Unt in such cases also the septum
is deviated to the left, the aorta to the right, and arises
from the right ventricle, or from both, owing to the
potency of the septum. Heine considers this deviation
of the septum as the primitive lesion. To it is due the
origin of the aorta from the right ventricle, whence, he
says, the blood finds such great facility of escape from
the ventricle, that less passes by the pulmonary artery.
This, therefore, partially atrophies from defective func-
tion.

Atresia of the pulmonary orifice presents quite dif-

112

THE MEDICAL KECORD.

fon'nt concomitant conditions from stricture. The
septum is or is not ileviatcd; the aorta, even by Heine's
atlinission, does not arise from the rif,'ht ventricle, and
tliis latter is atro|phied instead of bein|,' dilated and hy-
pertrophied. These cases of atresia of the oritice are
extremely rare. Peacoek only quotes twelve, and of
cases of atresia iinaceonipanied by obliteration of the
stem of the aorta I only lind fanr recorded. Tiie heart
nnder examination presents precisely an example of
this rare anom;d>'.

The moment at whiL-h the deviation from normal
development took jilaee may be fixed at somewliere
after the bepinnini: of the third month, for tiie septum
ventrieulorum is closed, and before the beginning of
the fifih, for the Eustachian valve persists. It is, in-
deed, so complete, that it seems preserved in the state
of its perfec-tion, at about the beginning of the fourth
month — t!ie probable period, therefore, at which the
hsi"!! in question occurred.

The nature of that lesion w.-xs a matter of great in-
terest. There was certainly no trace of emlocardiiis,
and the hypertrophied n)uscular tissue that filled up
tlie right ventricle did not present any obvious traces
of myocarditis, such has been insisted upon by Stolker
as a cause of pulmonary' stenosis.

Dr. Pit.nwm was inclined to ascribe the hypertrophy
to the existence of some obstacle ;it the pulmonary
orifice, that had necessitated great efibrt on the part of
the riglit ventricle at the very moment that the forma-
tion of the septum was in progress. A double impulse,
therefore, w.ns given to the growth of nmseular tissue,
and under its inlluence this became excessive, blocked
up the pulmonary orifice, and then, when the cavity of
the ventricle became useless, gradually obliterated it as
well.

The pulmonary congestion that immediately caused
death evidently resulted from an overloadin'jr of the
left auricle, charged with blood both from the right
auricle and from the pulmonary veins. The slightest
failure of power of the dilated left ventricle would tell
fatally upon such a morbid condition. The left ven-
tricle was obliged both to send blood to the lungs,
by the aorta, and receive it from tliem by the usual
channels. The circle of circulation was too small, and
finally btcame blocked at both ends. Then the heart
stagirered and succumbed.

The absence of cyanosis in this case, inexplicable on
the theory that cyanosis depends on a mixture of
venous and arterial blood, is easy to understand by
those who ascribe the blue coloration to a stasis of
blood in the venous capillaries, and to its insufficient
aeration by the lungs. Such stnsis had not had time
to take place during the short life of the child, and the
moment that aeration began to be insufficient coincided
with the invasion of the fatal pulmonary congestion.

Dr. J.\cobi inquired if the bronchial arteries had
been examined.

Dr. PrT.\.\M regretted that stich examination had
been forgotten until it was too hite, but observed that
the sufficiency of the ductus arteriosus rendered the
dilatation of the bronchial arteries unnecessary, and
therefore improbable.

Dr. J.\cobi, on examining the heart, observed that
it was indeed a ver}' rare cnse of anomalous formation.
He did not believe in explaining such anomalies b)-^ the
vague term " arrest of development," for that explained
nothing. The real question was, ii-hy had such an
arrest occurred? In the present ca-e it was noticeable
that the pulmonary artery was riding over the septum,
and arrested in its progress towaids the right, while
the ."orta was equally arrested in its march towards
the left. He was inclined to attribute the excessive

development of muscular fibre, which had thiikened
the septum, clo.sed the j)uhnonary artery, and obliter-
ated the right ventricle, to a myocardili-. He suggest-
ed that a microscopic examination, that should reveal
an excess of connective tissue relatively to the mus-
cular fibres in the neighborhood of the pulmonary
orifice, would render this origin almost certain.

Dr. PiTNAM had intended making such examination
for the purpose of settling this very question, but had
reserved it until after presentation of the specimen.

M.\.MMARV TIMOR (FIBRO-S.VCROMATOUS.)

Dr. Post presented a tumor removed by operation
from the lell inaunnary region of a lady aged 06. The
ma.>-s was as large as an ordinary mammary gland, being
the size of tl.e two fists. The patient was not con-
scious of the existence of the tumor until November
last. It had not been the seat of any pain, the general
health continued good, and the integument moved freely
over the growth. Q'here wa.s no attachment to the
pectoral muscle underneath. The general shape of tiie
tumor, as covered by the integument, was very nearly
spherical ; and there were some inequalities of the snr-'
face tiiat suggested the idea that it might be a cystic
growth. There were no enlarged plands in the neigh-
borhood, nor evidence of constitutional contamination
It seemed to be identified with the mnmmary gland
although it was separated at its upper portion. D
Post consequently removed the whole of the gland with
the tumor. He was, however, struck in its removal
with the fact that the tumor was remarkaVily loose ii
its attachments to the surrounding parts, and that then
were no vessels of any considerable size that were divi
ded in the operation. Only five ves.-els required to b«
secured, and the operation was done by acupressurei
On examining the tumor after closing the wound hi
was surprised to find that there was no intimate con
nection between the tumor and the mamniary glan "
The gland was atrophied, and all attachments to it were
very readil}' overcome by the handle of the scalpel.

The tumor was of hard consistence, and it creaked un
der the knife more than scirrhus. There'were no cavi
ties in its substance containing fluid, in fact there w
nothing like cancer-juice to be detected. The subcu
taneous veins were considerably enlarged. The tumo]
had not yet been examined microscopically.

He presented the following report from Dr. Dela
field of the microscopical appearances of the tumor : —

Tiie tumor consists of a firm, dense tis.stie, divided u[
in all directions by clefts and fissures. The solid por-
tion consists of connective-tissue fibres, mixed witi
large numbers of oval and fusiform cells. At the edge
of the clefts the tissue is not uniform, but is divided u]
into large tuft.*;. The clefts are lined with cylindricj
epithelium. The tumor belongs to a class which ha
been described under different names by dilTerent a
thors. — proliferous mammary cysts, cysto-sarcoma, et(
The explanation most generally received at present i
that theie is an intra-canaVcular growth of papillar
tumors from the walls of the milk-ducts, at the samd
time the milk-ducts are dilated. From this dilatation
and the filhng up of the dilated ducts with the soli
new growth, result the peculiar appearances seen io
this specimen.

The tumor is, technically speaking, a fibro-sarcom:
inter-canaliculare mammae.

The acu[iressure needles were removed forty-eigh
hours after the operation, and there was a prospect o
the wound heahng almost entirely by first intention

DEATH FROM HEART-DISEASE.

Dr. Finsell exhibited a heait taken from a colored

THE MEDICAL RECORD.

113

woman aged fifty, Avho died suddenly while in the act
of takuio- a cup of coliee at the breakfast table. The
aorta was the only organ that sliowed any lesion, vvhicli
was an extensive calcifieation jllh^t above the aortic
valves.

He also exhibited a heart taken from tlie body of a
man aged 35. lie was returning home on Saturday
evening when he met a prostitute Avho persuaded him
to accompany lier to her lodgings. After retiring to
her room, and fifteen minutes after having had connec-
tion, he was seized with a fainting spell, and before aid
could be summoned he Avas dead. The heart weighed
twenty-four ounces, and there was atheroma of the
aorta, with marked hypertrophy of the left vcntri^.le.
The brain was not examined in this ca=e.

Dr. Loomis was of the opinion thnt very few of the
large number of sudden deaths occurred from heart-
disease, although the heart was found to be diseased at
the time. This statement Avas founded on a careful in-
vestigation of 155 typical cases of heait-disease.

Dr. Post remarked that sudden death might be of-
ten caused by a minute lesion of the medulla oblonga-
ta, which lesion might be very readily overlooked
during an autopsy.

Dr. J. C. Petkrs in tliis connection referred to the
case of a patient fif his, in whom the only cause for
suilden death was fatty degeneration of the heart.

Dr. Loomis stated that, about a year and a half since,
lie exanuned a gentleman, eleven o'clock in the morn-
ing, and gave the opinion that the heart Avas perfecly
sound. The patient Avas in apparently good health at
the time. At one o'clock in the same afternoon he
died suddenly. A fcAV days before, this patient had
had his life insured for twenty-five thousand dollars,
and a gentleman Avho Avas called in after the death had
occurred offered the opinion that tliere had been heart-
disease. After considerable effort Dr. Loomis obtained
an autopsy, and succeeded in satisfying himself that
death Avas due to a large effusion of blood at the base
of the brain. Theie Avas a slight atheromatous condition
of the aorta, and the left ventricle Avas very slightly
hypertrophied, but these lesions were insignificant.

Dr. Putnam suggested that a broad distinction should
be made between aortic and mitral disease in regaid to
the liability of sudden death. Recent statistics had
shown that aortic insufficiency was particularly liable
to be followed by sudden death, and an ingenious ex-
planatiun had been given of its mechanism. When the
aortic valves are sufficient, the blood, suddenly arrested
by their closure, is forced into the coronary arteries
that arise behind them. When they are insufficient,
a li-rge pait of the blood passes back into the ventricle,
and does not pass into the coronaries. At all events,
the jet is not thrown Avith the normal force. The Avails
of the ventricle, therefore, are c mstantly growing
weaker from insufficient nutrition, while the cavity is
dilating from the increase of its contents, and the
brain suffeis from the general antemia so cliaracteristic
of aortic insufficiency. At a given moment, the com-
bination of these influences reaches some special crisis,
the heart staggers under an excessive afflux of blood,
at the A'ery time that it is deprived of its normal
stimulus from ner\'ous influx, and from the blood fresh-
ly circulatirig in its nutritive arteries, with an increas-
ed burden and less power to bear it, the heart comes
to a stand-still, and pauses in diastole.

Dr. Jacobi maintained that it Avas hard to prove or
to disprove this theory, except by tlie facts of clinical
experience. If the idea Avere tenable that the heart
Avill gJA'e out suddenly when not sufficiently nourisherl,
it was impossible to see Avhy a large number of persons,
under severe physical exertion and under great mental

emotion, should not die upon the spot. Tt appeared to
him that inasmuch as a large portion of tlic lieait could
be di.-integrated without causing inmicdiate death, a
sudden arrest of blood in the coronary could hardly 1)0
charged Aviih producing a fatal result.

Dr. Loomis remarked that the clinical hi-tory of
cases of aortic regurgitation militated against the
theoiy of sudden death from arrest of supply through
the coronary artery. Aortic regurgitation lir>t causes
a dilatation of tin; ventricle ; that dilatation is imme-
diately compensated by hypertrophy of th(! ventricular
Avails, The hypertrophy goes on j^u^'i passfi Avith the
dilatation until degenerative hypertrophy commences,
Avhen the dilatation gets the best of the race. Then it
is that the patient is in a condition to invite sudden
death, when the heart may be overtaxed.

Dr. Jacoei had never been able to convince himself
that any of his cases of death from heart-disease
occurred suddenly. lie did not recollect having seen
a case terminate in death in less than tAVO hours. Such
an one he called to mind in the person of a boy,
Avho died in two hours and a half from pulmonary
oedema.

Dr. Peugnet referred to the case of the late Dr.
Canimann, Avho died of degenerative hypertrophy,
caused by aortic ami mitral disease.

PULMONARY APOPLEXY.

Dr. F. exhibited also a case of pulmonary apoplexy
of the right lung, removed fiom tlie body of a German
aged 65. He Avas engaged in a quarrel with one of his
tenants in reference to chopping some Avood. It Avas
claimed that he was struck Avith an axe in the quarrel,
and that he had died in consequence. At the autoj sy,
hoAvever, no marks of the axe Avere to be found. On
removing the calvarium a large effusion of serum,
amounting to eight or ten ounces, w^ns discovered l>y
Di-. Cushman underneath the arachnoid. If there Avas
such a thing as serous apoplexy, Dr. F. Avas inclined to
call this such a case. The brain Avas not congested,
neither were its vessels gorged or distended. On open-
ing the chest the right lung Avas discovered to be the
seat of extensive pulmonary apoplexy. It was clear
that death Avas caused by this latter effusion, combined,
perhaps, Avith the serous apoplexy. The fatal result
occurred about an hour after the fracas.

Dr. Jacobi asked if the convolutions Avere not hard
and flattened, and on being answered in the aftirmative,
expressed the opinion that the supposed serous apoplexy
Avas evidently an old process.

DEATH FROM PYEMIA AFTER THE DIVULSION OF STRICTURE.

Dr. Keyes exhibited a specimen of death from
pyremia after the divulsion of istrieture. A Scotchman,
aged forty, Avas last month sent to hospital fi om the
workhouse. He was a stout, heavily built man, and
complained of stricture Aviih cystitis. A number 11
bougie (French scale) Avas readily passed, and, as the
patient desired to be relieA^^d of his trouble, a Thomp-
son's divulsor Avas introduced, and screAved up to 30.
The patient did not complain of any pain, until a No.
25 sound was passed, Avhen he also had a chill. A sub-
cutaneous injection of morphia Avas made into one of
his arms. Shortly after this he passed into a condition
of fever, Avhich lasted until death. The chill lasted
five minutes. His pulse went up very rapidly, so that
the next day it Avas 130-140. His skin was hot and
dry from one end of the disease to the other. He
drifted into a condition of delirium on the third day,
and his skin becairie yelloAV tAventy hours before he
died.

It Avas discovered that there Avas a little tenderness

114

THE MEDICAL RECORD.

beneath the scrotum, and on the tliinl day n lump
nboiit tlu' size of a marlile was discovered. The pa-
tient diod on tlie nintli day.

At the aiiiop.sy it wa.s di.'^covered that there was ex-
trava-atioii of urine; that there had formed pu.s in the
meshe.s of the scTotuin: that tliore was a small abscess
in the Moor of the urethra, just in front of tlie stricture.
There were also three aljscejses in th" pro.statc. The
bladder was hypertrophiod to a certain extent, and
pave evidences of the existence of clironie cystitis.
An ab<ces> the size of a marble was found in the sum-
mit of the left \uw^ ; the liver and spleen were soft, but
contiiined neither abscesses nor infarctions. There
wai> no trouble with tlie kidney*. The cavities of the
pleurje contained serous effusion, with a few floating
flocculi.

Tne specimen wa.s of interest as showing the results
of divulsion, viz. : tearing through of the mucous mem-
brane and of the stricture tissue, and als) as a case
terminating with pyaemia as the apparent result of the
operation. About five days after the operation the
patient was recognized by two others, who had seen
him in a strait-jacket, with violent mauid a potu, three
days bef ire his admission to the hospital. This fact
explained the reason why the condition of the patient
was such as to invite suppuration so readily. In fact,
this conlition was very manifest in the beliavior of the
hypodermic punctures, which degenerated into diffuse
.suppuration. The chill evidently did not have any-
thing to do with the pyaemia as an initiative.

The heart was enlarged, the lungs cedeniatous, and
the pericardium was adherent to the stomach.

EFFECTS OF HYPODERMIC IXJKCTION OF RESKNOID OF VER.\-
TRCM ALBUM.

Dr. PErGNKT presented the stomach, intestines,
uterus, and bladder of a slut, which were intensely in-
jected ; the coats of the stomach and intestines thick-
ened, and he believed presented evidences of inflam-
matory action. The specimen was un'que. and the only
recorded one having been produced by the hypoder-
mic iniection of j? gr. of the resinoid of veiatrnm album,
that is, its re-in deprived f)f its alkaloids, veiatroida (so-
called verat:ia) and j^rvina. It contains a distinct
organic principle, but not of basic origin. He had made
several experiments on various species of animals, but
had invariably obtained similar results, varving in in-
tensity as to the amount of resinoid administered, and
to the length of time it took to cause a fatal termina-
tion ; whilst he had never seen any similar effect pro-'
duced either by the veratroida or the jervinn, although
variou- observers had attributed this peculaiar action
of veratrun allmm to its veratroida. He con-idered
thv. in this principle resided the marked difference
between veratrum album and viiide. The kidneys and
ureters were normal, the liver dark and c.mgested, the
heart distended, ventricles filled with blood; ri<.'htlung
cingesteil, with ecchymotic spots on its surface, but
readily inflated. Its peculiar effect on the uterus
showed that t!ie cases of hemorrhage alluded to by
Orfili, in his treat-se on toxicology, as well as the case
which had come imder his own observation, was not
due to its mechanical action as a sternutatory when
applied to the nostrils, but to the congestion developed
in the uterus.

It is a c;irdiac poison, causing death by stopping the
heart's action at the diastole, owing to a gradual de-
struction of the excitabihty and conductive power of the
nerves of tiie organism, probably due to a paralysis of
the blood-vessi-ls of the nerve-centres.

Dr. J. C. Pkters alluded to the specific action of
certain medicinal agents on the alimentary canal, and

inquired if there had been any tiiminution of the
temperature in this case.

Dr. Pkuo.vet re[»lied affirmalivel}'.

Dr. Petkrs thought that it was intense hypcrajmia
or congestion, due to a paralysis of the vasa-motor
nerves.

Dr. PEroNET admitted that the hyperaimia or con-
gestion, as suggested by Schroff and confirmed by
(iililer, in reference to veratrum, would be accounted
for by paralysis of the vasa-motor nerves as its primary
action, but that if the animal lived long enough, gas-
tro-enteritis would be developed as a secondary one,
as observed by him in a case of poisoning, where the
patient took half an ounce of the homoeopathic mother
tincture of veratrum album, and was confined to her
bed for eight weeks, presenting all the symptoms of
gastro-enteritis, finally recovering with a contraction
of the colon, which caused an extreme attenuation of
the faeces, and that they only recovered their natural
form and size four months after.

Dr. Jacobi remarked that Dr. Peugnet had been
carrying on extensive experiments with the different
varieties of veratrum, and suggested that he should
make a micrcscopic examiiiation of the specimens.

The Society then went into Executive Se.-sion.

Stated Mediwj, Fehniary 28, 1872.
Dr. a. L. Loomis, President, in the Chair.

FOLLICULAR ULCERATION OF PREPUCE.

Dr. Post presented the inner portion of the lining
membrane of the prepuce removed by excision from a
married man aged forty-eight. The patient had a long
foreskin, which could be retracted only with difliculty.
The disea.se consisted in an extensive granulating ulcir-
ation, and also induration. It presented none of the
physical characters of the initial sore of syphilis, neither
was there any syphilitic history connected with the pa-
tient. None of the glands in the neighborhood were
enlarged. The ulcer was indolent in character, had
exi-ted for a period of three months, and seemed, in the
absence of anv other cause, to be due to a want of
cleanlines-s. The specimen was, on motion, referred to
the Committee on Microscopy.

PERFORATION' OF APPENDIX VERMIFORMIS BT F.ECAL
CONCRETIONS.

Dr. Mason exhibited some faecal concretions re-
moved from the appendi.x vermiformis of a stout, heal-
thy boy aged eleven years. The patient was taken
sick on "Wednesday, December 7, with what appeared
to be a .simple attack of cholera morbus. In the
morning his motlier gave him a dose of oil, which pro-
duced four or five large evacuations. Dr. Mason was
called to the patient on the afternoon of Thursday.
There was then a good deal of pain in the abdomen,
most intense, however, in the neighborhood of the
right iliac region. The nature of the casf was at
once suspected and an Ofduion given accordingly. The
patient was put under the opium treatment, and was
seen again at ten p.m. The pain was somewhat
easier, although it had exfende<l to the left side, where
there w;is also some swelling. There was then decided
tympanitis over tl:e whole abdomen. The opium treat-
ment was continued, when on Friday night the
pain became more intense. Six leeches were applied
to the part, with some benefit. The tympanitis in-
creased very much, and the pain seemed to be more on
the left side than on the right.

The temperature had been 103' F. ; pulse 130, and

THE MEDICAL RECORD.

115

respiration corresj)on(Ungly rapiil. On Friday these
symptoms improved, the temjierature fell to 98, but the
tympaniiis was still very eonsiderable. In fact, he ap-
peared to be so comfortable that hope was entertained
that there had been a mistake in the diaunosis, and that
the peritonitis was due to other causes than perforation
of tlie appendix verniilbrmis. On Friday night and
Saturday morning, however, all the symptoms became
suddenly worse ; there was intense pain in the region
of the diaphragm, and the pain in the left side also be-
came more considerable. On the Sunday following, he
being no belter, Dr. Flint was called in consultation, and,
despite a very careful examination, no tumor could be
detected. The case was then regarded as one of gen-
eral peritonitis, due to other causes than those which
referred to the appendix. He gradually grew worse,
and sank on Monday morning, lie died just seven
days after he was fust taken sick. During the last
twelve hours of his life opium seemed to have no effect
in allaying pain, notwithstanding over a hundred drops
of the tincture were taken in three hours. In addition
to this, a grain and a half of morphia was injected sub-
cutaueously, but with no marked elTect. As a last
resort, chloroform was administered continuously dur-
ing the last six or eight hours of life.

Autopsy. — On opening the abdominal cavity, there was
not that escape of gas which we usually notice in per-
forations of the appendix, but intense peritonitis was
very evident. The ascending colon was bound down
by a false membrane which surrounded the whole of it ;
and directly behind the colon, commencing a little
above the crest of the iUum, was a large abscess, which
extended along the under surface of the diaphragm. It
was covered by a thick layer of lymph, and so were the
upper and under surfaces of the liver. The intestines
on the left side were also bound together by a large
collection of lymph. The appendix was unusually long,
measuring about five inches; and there were two per-
forations in it, the upper one about an inch and a iialf
from the commencement, and the second about half an
inch below the first. Projecting through the first open-
ing was a concretion about the size and appearance of
a date-seed. The extremity of the appendix was in a
gangrenous condition. During all his sickness there
was no trouble in evacuating the bladder.

The concretion was nothing more than hardened
fecal matter arranged in concentric layers. There
were eight of these rings, and in the centre of the mass
was a wiiite substance which resembled lime.

There was no swelling on the right side, that might
have led to the suspicion that there Avas an abscess in
that situation. Even if there had been a certainty that
an abscess did exist, there would have been no chance of
reaching it by an operation, the collection of pus being
much higher than usual in these cases.

The tvmpanitis was so extensive that the practica-
bility of puncturing the transverse colon was seriously
entertained. In conclusion. Dr. Mason remarked that
Dr. Parker advised, before operating in these cases, to
wait until the fourtli or fifth d;iy, but in the present
instance the peritonitis conunenced from the start.

New York City Lun.\tic Asylum. — Dr. R. L. Par-
sons, Resident Physician of this Institution, in his an-
nual report ibr 1871, states that 780 patients were ad-
mitted during the year 1870. 453 were discharged.
132 died. Of those discharged, 212 recovered; 129
improved; 112 showed no improvement. The irn-
poitance of greater care on the part of physicians who
sign certificates of insanity is forcibly dwelt upon by
th^s writer.

NEW YORK ACADEMY OF MEDICINE.

Stated Meeting, March 7, 1871.

Dr. E. R. Peaslee, President, in the Chair.

{Discussion on Dr. Loving's i^aper, vide imge 97)

Dr. Notes. — I agree with the statements made by
Dr. Loring in the rules for peribrming the operation for
strabismus. The certainty which can be secured in the
cosmetic eflect by attention to these rules is in strong
contrast with the variahle and sometimes deploraljlo
lesults which followed the operation in its beginning.
Yet even now a slight divergence wi'l sometimes ensue
after operating for convergence. This is doubtless due
to the extent of incision made in the capsule of Tenon,
and what Dr. Loring said about the variable strength of
this tissue is to be remembered in making the subcon-
junctival incision. I have not been favorably impressed
by the so-called subconjunctival method of operating,
but choose rather a small opening over the insertion of
the muscle and close it up by a fine suture. In only
some rare cases have I employed the suture through
the outer canthus, which Dr. Knapp first suggested ; I
have found it answers the indications. I have not
been in favor of operating upon very young subjects.
My reason is that, at a very early age, it is impossible
to use those optical appliances which are indispensable
to many cases of strabismus. The problem is IdiIi
optical and mechanical, and I do not find any certainty
in the results unless the optical conditions are fultilled.
Hence for a young child in whom the convergent st a-
bismus has not become decided, I prefer to postpone
the operation until 6 or 8 years of age, and, to avoid
impairment of sight by disuse of one eye, direct the
parents to cover the eye, which is habitually used so
that the child may be compelled to keep up the practi;'e
of using the other. In one class of cases, I am stron<.ly
in favor of not operating at an early age, viz. whei-e
strabismus, as is not infrequent, comes from opacity ot
the cornea. This kind of strabismus is extremely apt
to disappear or to greatly diminish as a child grows.
Probably because, as the opacity fades away and vision
improves, the effort to see makes less demand on the
accommodation, and consequently less on the interni.
For such cases there is hope of a spontaneous cure, and
danger that an early operation may at length bring
about divergence of the eye.

I have seen a statement by some one that he had
obtained binocular vision in from GO to 80 per cent, of
cases operated on. If by this is meant that true binoc-
ular vision, as distinguished from apparently correct po-
sition of both eyes, was secured, I am at a loss to credit
the statement, li is perfectly true that in this propor-
tion of cases the eyes may, so far as their motion and
look is concerned, act like a normal pair, and the person
be supposed to have binocular vision. But in very many
such cases, I have been wholly unable to get evidence
that there was true binocular vision. Tests fur double
images and by the stereoscope and by other means
would show that one eye only was employed in seeing.
and the other followed after in a merely mechanical
way. I do not believe that true binocular vision, the
conscious participation of both eyes, is secured in more
than 25 to 35 per cent, of the cases. The cosmetic re-
sults, however, which are what the public demand, are
far superior to this ; but the aim of the surgeon is to
restore the physiological unity of the two eyes il' possi-
ble. This subject,' however, is a very large one, and
on this branch of it Dr. Loring has not touched. For
strabismus as a purely surgical proceeding, he has
certainly stated the appropriate rules of treatment.

116

III: MEDICAL RECORD.

Dr. Roosa would like to ask Dr. Loring in regard
to a point made in the bopiniiing of his papi-r as to the
causation of squint. Ilr luulerstooil Dr. Loring to say
thit lie disiigreetl with Dontli-r's statt,'Mi('nt, that there
were scarrely any cases of convergent squint tliat were
not causi! 1 by a shortened condition of the eyeball
(hypennclropia) ; and to state, that there were many that
were dependent upon straining ortheaeconiniodation and
weakness of the externi. While the speaker under-
p'ood and aec -pted this view, lie wished to know if Dr.
Loring meant to teach, also, that the habit of imitation,
«. <"., a child imitating one who squinted, would of itself
cd'ixe strabismus.

Dr. Roosa also asked if Dr. Loring made a literal quo-
tation from Stdlwag in regard to the time for operation.
He liad been under an impression, probably erroneous,
that StelUvag recommended the period at which chil-
dren began to use their eyes upon near objects as the
proper one for operation.

In regard to the first question, Dr. Loring said that
Dr. Roosa must have misunderstood him. as be had not

and adJuctive excursions of the squinting eye were
equal to those of the fixing eye.

Concerning the possibility of determininq the effert ai
an oriihtr ieiiotoini/, Dr. Knapp thought, with Von
Graefe, that this could be done liy a ean-ftil operator,
with an approximation sufBeit-nt to promi.sc a sucfe.^s
in all casf'se.Ki'cpt. perhaj)S, two or three percent., which
also might still be corrected by a subsecpu-nt advance-
ment. The ell'ect of each operation had to be examined
and modified, if necissary, one or several hours after
the tenotomy. There was no need of waiting eight or
twelve hours for making these examinations and cor-
rections, and if Von Graefe recommended so long an
interval, his practice was strangely at variance with hi,-
teaching. lie hardly ever performed an operation be-
fore three or four o'clock in the afternoon ; and it, would
have been rather inconvenient to make the corrections
eight or twelve hours la'er.

In regard to the re-estahliRhrrtenf of stereoscopic visioii.
by the operation for squint, Dr. Knapp confessed him-
self to be the author of the statement Dr. Xoyes had

alluded to the fact that strabismus could be caused by I alluded to, thongh he <lid not now remember the per
imitation. What he intended to say was that often- centage of oases in which stereoscopic vision Ava-; ob-
limes a condition was produced in emmetropic eyes by tained. He had, eight or nine years ago, compiled a
debilitating diseases which gave rise to factors which larger number of .successive squint-operations made by
were precisely similar to those which existed in hyper- ( him, and, if his memory served him, about CG per cent

metropic eyes from congenital malformation. Thus
some temporary reduction in the power of the ciliary
nmscle would Ibree emmetropic eyes to use an increas-
ed amount of accommodative effort with moderate
degrees of convergence, which is the essential cause of
squint.

In regard to the passage in Stellwa'j, Dr. Loring re-
maiked tliat he had copied it from the last edition of
the American Translation.

Dr. Kn.\pp remarked that the snhconjunctivril tenotomy
was neither difficult nor uncertain, but had the advan-
tage of causing less extensive wounds, smaller effects,
and less tendency to sinking of the caruncle and protru-
sion of the e5'eball. If, on examination after the opera-
tion, the effect was found to be too small, it was easier
.|ind surer to increase it to the desired extent by divid-
ing the conjunctival bridge over the previous insertion
of the tendon than to reduce, by means of sutures, too
great effects which followed not infrequently the ordi-
nary tenotomy, as advocated by Dr. Loring.

Dr. Kk.\pp described the mode in which the subcon-

or 75 per cent, of them were followed by binocid.ir
fixation in all available parts of the visual field. Graefe,
who had published statistics less favorable, had later
declared himself in agreement with Dr. Knapp's residts,
since he had operated on children more frequently than
he used to do before.

Dr. Knapp was of opinion that strabismus should h"
operated on us soon as it was manifest. Postponing the
operation, very rare cases of spontaneous recovery ex-
cepted, could only place the patient into less favorable
conditions as to the preservation of good sight in the
.squinting eye, and the restoration of binocular vision,
which was the less apt to take place the longer strabis-
mus was allowed to exist. He had repeatedly and al-
ways successfully operated for congenital squint on
children, three or four months old. The operation, in
the first years of life, was rather difficult, and threw a
great responsibility on the operator, as he had less
factors at his command to calculate tlie desired effect,
but the innate tendency to binocular fixation then was
still in great force, and commonly compensated small

junctival tenotomy should be performed, stating that a j inaccuracies of the operation. As a ruleless extensive
neat operation required only four or five strokes with j tenotomies should be made in children, and even in
the scissors, two for the division of the conjunctiva and i subconjunctival operations limiting sutures were often
Tenon's capsule, and two or three for the division of | necessary. In no case, whether of an aflult or child,
the tendon. j the mobility of the operated eye should be reduced be-

With regard to the application of sufitres to increase yond the natural limit. This was the mechanical and
or diminish the efed, he said that Graefe's plan, of pass- ' most important side of the operation for strabismus

in^: sutures only through the conjunctiva, mostly gave
insnfficient effects, at any rate the obtainable results
could not be calculated wirh any degree of certainty.
Oblique sutures, if they had any effect upon the tendon,
were ii.able to change its physiological direction, caus-
ing secondary d<;viation of the globe, and should
therefore be avoided.

The opjr.ition for squint was mainly a mechanical
problem. In the development of internal squint there
was always a strugtrle between forced convergence and
forced accommodation, or between stereoscopic and
a -ute vision. Which of the two got the ascendency,
seemed to be more or less accidental. A weakness of
the external recti, which Dr. Loring alleged, could not
be regarded as a predisposing cause cJf convergent stra-
liismus, as one of the essential features of concomitant

In convergent squint, experience had taught him that
the effect of a tenotomy was excessive, if, one or two
hours after the operation, the inner margin of the
cornea could not be moved as far as to the caruncleJ
The success of squint operations, in his opinion, de4
pended more on the close observance of these mechanij
cal laws, than on most of the other factors that enterea
into the problem.

Dr. R. H. Dkrby. — I cannot agree with Dr. Knap^
at all in his estimate of the value of Von Graefe'a
suture. In excessive degrees of convergent squint w<
can accomplish by this suture any possible desired cor4
rection. A methodical increase of the effect of the oper-j
ation of any degree may by this means be secured|
Von Graefe found this suture of so much value that bt
latterly almost never practised the operation of .sewing

squint was the maintenance of power both of the inner ! forward the muscle.' The danger that Dr. Knapp
and outer recti, shown by the fact that the abductive | alludes to of the obliquity of the suture causing a ver

THE MEDICAL RECORD.

117

tical dovi.ition of the optical axis is, if the suture be
properly apphed, ratlier imaginary than real. Acoord-
ir.g to the breadth of the transfixed bridge of conjunc-
tiva the eye lolls more or less toward the nieiHan line.
If ih(^ amount of convergence was excessive, more than
3-4 hues, I have been in tlie liabit of contenting myself
with a partial correction of the squint and ultimately
making a compensatory^ operation on the fellow-eye.
During the period of my assistantship at Von Graefe's
elinique I had almost daily opportunity of seeing the
value ol' this suture to increase ti'.e effect of a tenotomy,
and 1 have never known it to reduce a vertical squint.

Von Graefe has long since pointed out the impor-
tance of making the conjunctival wound very small in
the operation of tenotomy. Sinking of the caruncle is
by this precaution reduced to a minimum. After an
operation for convergent squint there should remain
two or three weeks after the operation a convergence
of tliree-quarters to five-quarteis of a line. This is not
merely lor the sake of cosmetic eft'ect (that is on ac-
count of the apparent divergent squint of hypermetro-
pic eyes), but because after this period there is always
a gradual increase in the effect of the operation.

Especially important is it, after a squint o]ieration, to
ascertain, by means of a prism with its base downwards,
the dynamical relations of the lateral muscles ; for often
after a tenotomy for convergent squint there is a ten-
dency to divergence. Should we now find a prepon-
derance of muscular action in favor of the external recti
we mu>t see that enough accommodative effort is called
into play to counteract the tendency to divergence.

Of the amblyopia that is fouml in monolateral squint
three stages or rather forms have been distinguished.
In the_/fr.s^ form the acuity of vision is diminished — there
|is simple dulness of the retina. In the second form the
Ipower of fixation is impaired; the patient makes a feel-
ing movement with the macula lutea, and he sees
jobjects better that lie toward the temple than those
that lie toward the nose.* In the third form the inner
half of the retina has better vision than the macula.
■This classification is of great importance for the prog-
'nosis. The dulness of the retina described under the
Uirst form is entirely curable and often disappears im-
niediately after the tenotomy. In the second form the
jimprovement comes, but is only partial and gradual.
I For the third form the chances of improvement are
very small.

I Dr. T. R. Pooley concurred with Dr. Knapp in
ithinking the subconjunctival the best method of oper-
iating. It was not difficult of execution, provided the
l.^onjunctiva was grasped close to the sclei'otic, so as to
iinsure the opening of Tenon's capsule. The method of
ipperatiug proposeil by Dr. Loring, of introducing the
(jiiook from above, and exoosing the whole insertion of
' the muscle, and the too free dissection of the capsule, is
likely to be followed by undue reaction. The vertical
-'Uture could have no diminishing effect. A suture de-
signed to diminish the effect of the tenotomy should be
passed horizontally in a place with the muscle and
leeply enough to embrace part of the tendon in its
grasp. Ho thought it advisable to operate without an
Hannesihetic whenever practicable, in order to control
the elTec's as soon after the operation as possible.

The Endoscope. — Dr. Robert Newman, of New York
Trnns. Med. Soc, X. Y., 1870), gives a practical paper
jon the use of the endoscope in the treatment of dis-
jeases of the female bladder and urethra. It is pro-
fusely illustrated with diagrams. Six cases, selected
from many others treated at the Woman's State Hos-
jpita', under the care of Dr. T. A. Emmet, are detailed.

CotrespoutieiiCie.

Ipita'

THE SELLING OF DIPLOMAS.

To THE Editor op the Medical Record.

Sir : Duty to myself, not favor to persons or colleges,
— for I never knowingly do favors where crime may
possibly be abetted thereby — renders it requisite to say,
that on further investigation, I find that there is no
evidence within my reach, which will justify the fol-
lowing raragraph of my letter published in the pEconn
of the 15th March inst. as regards the College alluded to.

"Besides such outrageous acts, it is credibly stated
that this same college advocates the propriety, and fol-
lows the practice, of selling their diplomas to persons
living in distant parts of the State, on the simple state-
ment of the person seeking it, without any presentation
of certificate or credentials. "

I had either misapprehended the statements alluded
to, or they incoirectly represented the only written
evidence I have yet seen upon this matter of the prac-
tice of the said college, of giving diplomas without
examination.

So far as the evidence before me goes, the college
offers to examine any graduate of a medical college,
and, if satisfactory, to give him a diploma for ,$35.

It also oflers to receive the diploma by mail, or in-
deed any certificate of graduation, and, excusing the
examination, 'issue a diploma for $175, that is, charging
$140 more when they do not examine, than when they
do examine.

Respectfully,

Stephen Rogers.

March 30th, lS7;i.

Hciu 3nsttuntcnt3.

DESCRIPTION OF A

NEW SCARIFICATOR TO FACILITATE
VACCINATION.

By B. F. DAWSON, M.D.,

ATTF.N'DING PHYSICIAN TO THE NEW YORK STATE WOMEN'S HOS-
PITAL, ETC.

The threatened epidemic of small-pox during the pa-t
winter greatly increased the vaccinating duties of phy-
sicians. In the frequent performance of the operation,
in common with many others, I felt the necessity of a
scarificator which would combine the three great re-
quisites of painlessness, rapidity^ of action, and sim-
plicity of mechanism. While thinking over the mat-
ter, the following instrument suggested itsell", and
through the assistance of Mr. Stohlman, of G. Tie-
man & Co., of this city, has been just prit into form.

The accompanying illustration represents the exact
size of the instrument, which admits of its being car-
ried in the vest pocket.

The construction of this instrument is as follows : a
simple tube through which runs a steel rod connecting
with the handle («), 3.nd terminating in six needle
points shown in woodcut; a spiral spring encircles this
rod, being fistened to it at the needle extremity and
connecting with the outer tube at the insertion of the
liandle (a). A rachet catch (e) prevents the recoil of
the spring when wound up, which is done by turning
I, the handle (a) with the right hand, from riijht to left,

118

THE MEDICAL HECOKD.

until it winds no further. The regulatin}? i>icce (h) en-
ablrs tlif ile-ired exposure of the lU'cdlcs, which shouhl
projt'ct but sliglitly beyond tlie end of tlie instrument,
'file intitruinent, being wound up, is ready for use. Tlie

operation is performed by taking the scarificator in the
right hand, the thumb being against the rest (</), and
tlie sfcond fini^er lightly resting on the spring lever (c) ;
the fir.<t fingi'r lies over the instrument, and thus com-
pletely conceals it, which is a great advantage in oper-
ating en chi'dren. Pressing the end of the instrument
against the arm, the second finger is instantly pressed
against the Nver beneath it, by which act the spring is
lilieiated and the needled instantaneou.sly revulve and
produce three perfect circular scarifications. By un-
screwing the regulator (/>). the needles can readily be
cleaned by wiping or passing through a piece of soft
paper.

Several of my friends and others have used the in-
strument, and to all it has given the most perfect satis-
faction.

When carrying it in the pocket, the needles can be
well protected by the regulator (b).

(Dbitimrii.

PROF. SAMUEL JACKSON, M.D.,

OF PniLADELPniA.

Dr. Samtel Jackson, Emeritus Professor of the Insti-
tute of Medicine in the University of Pennsylvania,
died, April G. at his residence, in this city, at tlie ripe
old age of eighty-two. He was born in Philadelphia on
the 22d of March, 17S7. He devoted his time with
great energy to the study of his profession, and was
successful in acquiring a high standing in its practice.
In 1835 he was elected professor of the Institute of
Medicine in the University of Pennsylvania, a position
which was filled by him during a period of twenty-
eight years, with great credit both to himself and the
institution. He was one of the cleare-t lecturers and
profoundest scholars, and occupied a jfront rank in the
corps of professors of the university, a body of men
which has long enjo\-ed the highest reputation fir skill
and learning throughout the world. In 1863. in con-
sequence of his advanced age, he abandoned the active
duties of his professorship, and has since held an
Emeritus relation to the university. Prof. Jackson
wrote several works on medical and physiological sub-
jects, the most celebrated of which were a treatise on
the " Principles of Medicine," first published in 1832,
and an "Introduction to Lehman's Chemical Physi-
ology," published in 1856. — Philadelphia Liqnirer.

ARMY NEWS.

Official List of Changea of Stations and Duties of Offi-
cers of (he ^fedica! Department, United States' Army^
from March 19, 1872, to April 4, 1872. inclusive.

Fryer, B. E.. Surgeon.— By S. O. 43, Department of
the Missouri, March 20, 1872, assigned to duty at Fort
L'nion. N. M.

Storrow, S. A., ARsistant Sursreon. — By S. 0. 77,
War D-partnienf, A. G. 0., Ajiril 1, 1872, giaiittd leave
of absence for si.xly day.»».

Breweii, J. W., Assistant Surgeon. — By S. 0. 47, C.
S., Department of the Missouri, assigned to duty at
Fort Dodge, Kansas.

Tremai.ne, W. S., Assistant Surgeon.— By S. 0. 47,
Department of the Misi^ouri, March 25, 1872, assigned
to duty at Fort Lamed, Kansas.

Monroe, F. Le B., Assistant Surgeon. — By S. O. 74,
War Department. A. G. 0.. March 28, 1872, relieved
from duty in Department of the Platte, to proceed to
Boston, ^^ass., reporting on arrival by letter to the
Surgeon General.

Latderdale, Jxo. v., Assistant Surgeon. — By S. 0.
77, C. S., War Department, A. G. 0., granted sixty
days' extension of leave of absence.

Wir.soN, A. D., A.ssistant Surgeon. — Bv S. 0. 42,
Department of the Platte. March 21, 1872. granted
leave of absence for 30 days, on Surgeon's Certificate
of Disiibililv.

iHctiicnl 3tcm5 anti llcms.

Prof. Samcel Henry Dicksdn, M.D., LL.D., died
in Philadelphia, March 31, 1872. We shall give an
obituary sketch of the life and services of the deceased
in our next i.-sue.

Dr. Samuel A. Billing, a prxjminent physician of
Columbus, Georgia, died March 19, aged sixty-five.

S-MALL-Pox seems to be on the increase in the city ;
the weekly average being one hundred cases, of which
the average mortality is thirtjj-seven. In Philadelphia
the epidemic is on the decline, although a weekly ave-
rage of eighty deaths is reported. In Boston the epi-
demic is on the increase.

In the Report of Prlr. Wunderliehi Director of Clie
Charite Hospital at Leipsic, on the Small-Pox Epide-
mic in 1871, we find the following statistical statements:
Small-Pox was widespread and verv virulent. Re-
maining in hospital, at the end of 1870, were twenty-
six patients; new cases during 1871, 1,654; TC^hole niim-;
ber treated, 1,680; males, 1,108; females, 572. Re-
maining at the close of 1871, were thirteen patients, all
of whom have since recovered, save one. .Of 141 never
vaccinated, 101 or 71 3-5 per cent, died; of 56 unsatis-
factorily vaccinated, 30 or 53|^ per cent, died ;" of 20 who
had small-pox before, 5 or 25 per cent, dfdd ; of 1,463
vaccinated, but not revaccinated, 118 or 8 per cent,
died. Ninety-five cases of suspected small-pox were
received, in which the disease did not fuUy develop,
all were vaccinated and recovered. The epidemic
was at its height between ^larch and June ; the highest
number of cases was reached on May 21st. Towards
the close of June the cases rapidly diminished, and in
September there were received but ten cases.

Vaccination. — Total vaccinations in New York, from
January 1, to April 1, 1872, by Assistant Health
Inspectors, was 112,181, by PoUce Surgeons' about 8,000
additional.

Ceuebro-Spinal Meningitis is quite prevalent in
this city and vicinity, and threatens to become epide-
mic. In anotlier part of the Record we publish some
cases by Dr. Packard, which, we doubt not, will be read
with interest.

THE MEDICAL RECORD.

119

Amkrican Mkdical Association. — The Twenty-third
Annual S.'ssion will be held in Horticultural JIall, Broad
Street above Spruce, on Tues^day. May 7, 1872, at 11

A.M.

The following arrangements have been made with
the diflerent railroads : —

Union Pacific, return free, if first-class tickets are
bought, and an acknowledgment taken from the agent;
Cumberland Valley, excursion tickets ; Orange, Alexan-
drii), and Manassas, half fare for reiurn; Pittsburg, Cin-
cinnati, and St. Louis, excursion tickets; Piitsbuig,
Fort Wayne, and Chicago, excursion tickets; Cleve-
land and Pittsburg, excursion tickets ; Central Railroad
of Georgia, return free ; Richmond and Petersburg,
return li\e ; Wilmington and "Weklon, excursion tickets
one fare; Wilmington, Columbia, and Augusta, excur-
sion tickets one fare ; Kansas Pacific, one and one-fifth
fare for excursion ; Atlanta and New Orleans Short
Line (A. and W. Pt. Western, Mobile, and M.N.O., M.
and Texas Railroad.s, return free ; Western and Atlantic,
excursion tickets one fare; Western Alabama, excur-
sion tickets one fare ; Evansville and Crawford»\'ille,
excursion tickets; Lehigh Valley, excursion tickets one
fare; Louisville and Nashville, excursion tickets ; Mem-
ph'S and Louisville, excursion tickets ; North Pennsyl-
vania, excursion tickets two-thirds fare ; Pennsylvania
Central, excursion tickets; Philadelphia and Erie,
excin-sion tickets; Philadelphia, Wilmington, and Bal-
timore, excursion tickets ; Philadelphia and Reading,
excursion t ckets at two-thirds; Baltimore and Oido,
excursion tickets; Lake Shore and Michigan Southern,
excursion tickets, if forty are taken.

All who desire to avail themselves of the above

rates must send to the-Secretary, Dr. William B. Atkin-

■ son, 1,400 Pine Street, Phila., their fall names, and the

names of all the^ailroads over which they must travel

in coming to the session, with stamp for postage.

Camden and Amboy, excursion tickets at $4 from
New York to Philadelphia and return, if fifty tickets
are taken. For this ticket send money to Dr, A. E. M.
Purdy, 123 East Thirt.y-eighth street, New York. From
Montgomery, Ala#,- to Philadelphia, and return (by Ten-
'Viessee), SS'O^SO."*^ Apply through Dr. R. F. Michel,
?tlontgomei\y, Ala. From "Wasliington to Philadelphia
andretuinj $6, if fifty tickets are taken. Central Paci-
fic, half loc^l rates.

'T«E Medical Register of New York. — The tenth
volume "of this important work, to be issued June 1st,
1872, un'der the auspices of the N. Y. Medico-Histo-
rical Sociely, will contain a likeness of Dr. George H.
Tucker, deCeaied, editor of the first Medical Register
published in flifs country ; also a condensed description
of the objects, character, and field of operation of the
Hospitals, Infirmaries, Dispensaries, Asylums, and
Medical and other Scientific Associations of New York
City and its vicinity, and the Charitable Institutions of
New York, New Jersey, and Connecticut, etc. It will,
as usual, also contain inlbrmation resi)ecting the Colleges
of these States, a List of Physicians in good standing,
practising in New York City and adjoining places, their
residences and office hours ; also a List of County Med-
ical Societies of New York, New Jersey, and Connecti-
cut, their officers and members, with post-office ad-
dresses, and short obituaries, as i'ar as can be obtained,
of the physicians of these counties, recently deceased.
Committee of Publication. — Drs. Frederic Elliot, Ells-
worth Eliot, Edward C. Woodbury, William T. VVhite,
President, and Alfred E. M. Purdy, Editor.

New York Academy of Medicine. — At the stated
meeting, held March 21st, 1872, Dr. E. R. Peaslee, in

the Chair, Dr. James L. Brown read an important paper
on " Clim'cal Observations on Pelvic Peritonitis and
Peri-uterine Cellulitis." Drs. Noeggerath, Barkir, Tho-
mas, and the Presidmt entered into t'.ie discussion of
the paper. Dr. Brown's paper will be publishtd in
extenso in the American Journal of Medical Sciences.

At the stated meeting, held April 4th, 1872, Dr. E.
R. Peaslee, in the Chair, an interesting and ex-
haustive piper, with cases, on "The Mechanism of
Spontaneous Active Uterine Inversion, and the Reduc-
tion of a Case of Complete Inversion by the Combined
Rectal and Vaginal Taxi.«," was read by Dr. Isaac E.
Taylor. It was discussed by the President ; W. C.
Roberts, Vice-President, and the Author.

Dr. Henry GrisAvold was elected Resident Fellow.

The Secretary then read the names of the fallowing
gentlemen, who were elected by the Council, Delegates
to the American Medical Association to be held May
7th, 1872, at Philadelphia, Pa.; Drs. Cornelius R.
Agnew, James Anderson, James L. Banks, Gurdon
Buck, James 0. Pond, Alfred C. Post, Samuel S. Puri)le,
Frederick A. Burrall, T. Matlock Cheescman, John C.
Draper, Thomas Addis Emmet, Austin Fhnt, Joel Fos-
ter, Ehsha Harris, John H. Hinton, Edward H. Janes,
E. Lee Jones, Ernst Krackowizer, Ciiarks Carroll Lee,
Stuyvesant F. Morris, Jeremiah C. Morton, Charles W.
Packard, Edmund R. Peaslee, Gouverneur M. Smith,
Bradford S. Thompson, and William T. White.

The President annoimced that he had invited Dr. J
Parigot, formerly of Belgium and late of Brazil, a weli-
known expert in psychology and psychiatry, to read a
paper, April 18th, 1872, on " The Influence of Philoso-
phical Speculations on Medicine : its Practice and Med-
co-Legal Questions of Insanity." The views of Darwin,
Huxley, Maudsley, and others of that school will be
reviewed and combated.

A Valuable Medical Library for Sale. — The val-
uable library of the lat^«frof George C. Blackman,
M.D., of Cincinnati, containing upwards of three thou-
sand volumes of medical works, besides many pam-
phlets, journals, and papers, is now in the hands of Mr.
Robert Clarke, of Cincinnati, for public sale. We agree
with the Editors of American Practitioner, that the
library should be owned by some public institution or
association, similar to the New York Medical Library
and Journal Association.

The University of Louisville. — The degree of doc-
tor in medicine was conferred on eighty-four graduates,
at the Thirty-Ofth Commencement of the Medical De-
partment of the University of Louisville, held March 1st,
1872. The ad eundem degree was conferrt-d on five
practitioners Prof R. 0. Cowling, M.D., delivered the
valedictory address of the Faculty.

Chicago Medical College. — The Commencement
Exercise of the Chicago Medical College — Medical
Department of the Northwestern University — was held
March 12th, 1872. Diplomas were given to thirty-two
graduates. Two received the ad eundem degree.

Jefferson Medical College. Phila. — The Annual
Commencement of this College took jilace at the Aca-
demy of Music, March IGth, 1872. One hundred and
thirteen giaduates received diplomas, of whom fifty-
four were from the State of Pennsylvania. Prof Joseph
Pancoast, M.D., delivered the valedictory address.

University of Nashville, Tenn. — The Twenty-
second Annual Commencement of the Medical Depart-
ment of the University of Nashville was held February
22d, 1872. Diplomas were awarded to eighty-four
srraduates.

120

THE MEDICAL RECORD.

Women'8 Medical College, Philadelphia, Pa. — At

the Twentieth Annual Coininencenient of tliis Institu-
ti in, liild Miiicli 'Jlid, 1S72, thirteen huhi-s rcrcived the
dt'proe ol" Do(.t<ir in Medicine. Prof. Henry Hart-home,
M.D., delivered tlie closing address.

MissKSOT.v State Medical Socikty. — The fuHowing
officers Were elected for the ensuing year : President,
W. W. Mayo, M.I)., Rochester, Minn.; Vice-President,
W. L. Lincohi, M.D., Wabashun, Minn. ; Correspond-
ing Secrcta-y, W. F. Hutchinson, M.D., MiiineapoIi.s,
Minn.; R.-cor.iing Secretary, C. E. Smith. M.D., St
Paul. .Minn.; Tie!U-;,ner, S. P. Shcardoun, M.D., Stock- I
tnn, Minn.

PiiECOi-iors DnvKLorMENT. — Fliigel de.«cribc-; in the
liinjr. iirtzl. Intell.-BUitt. the case of a female child who
(lied of dianluea at the age of five and a half years,
having attained tl:e height of five feet. Tlie incisor
tectli all appeared when she was six months old, and at
nine months she had all the molars. At a year and a
half of age she menstruated, and, es[)cciall3' in her later
years, the periods were tolerably regular. The exter-
nal genirals, excepting the absence of hair, were well-
developed ; the breasts were full, and the pelvis roomy.
The condiiion of the internal genitalia was not ascer-
t lined. As regards her intellect, she did not appear to
be in advance of other children of her age, although
she had begun to speak when six months old. — 13r.
}[eO. Journ.

Deficiency ok Lime and Piiospiioiuc Acid in the
Boxes. — Dr. Weiske shows in experiments upon the
goat, publ shed in the Zeifschri/t far Biolor/ie, that the
withdrawal of phosphates from the food proves injuri-
ous to that animal, and may, in fact, lead ultimately to
its death ; Init that the bones do not appear to be ren-
dered therebv' more friable, or to undergo any change.

The Jefferson Medical College of Pnii,.\DELpniA
has, during tiie period of its existence as an educational
institution, graduated six thousand and fifty-four medi-
cal students.

Carbolic Acid Pills. — The following is a useful for-
mula : 1> Carbolic acid, 3 drops; Sonp powder, O.GO
gram. ; Lycopodium, 0.06 gram. ; Pulv. tragacanth, 2
scruples. Make six pills. — Drug. Circ.

A New San Francisco Medical Journal. — A
monthly medical journal, called The Western Lancet,
was started in Jannary, at Sm Francisco, Cal. The
new enterprise is edited by Eustace Trenor, A.M., M.D,,
and Heman P. Babcock, M.D.

Four Children at a Birth. — A woman, residing at
Noithampton, Mas.s., gave four children at a birth.
The mother and children were doing well at last ad-
vices. She has had seven children within t!ie last thir-
teen months.

De.\dliness of "War-Weapons.— Of 3.453 Germans
wounded before Metz, no fewer than 95.5 per cent,
were struck by Chassepot balls. 2.7 per cent, only were
wounded by projectiles from heavy guns, and there
were only 0.8 jer cent, of wounds from cold steel. No
fewer than 25,000 Frenchmen in all were struck by the I
projectiles of the German artillery. This pives an I
average of one elTective shot in every three fired from
the German batteries, a result which appears hardly
credible.

Unfortunates in this Country. — .A.ccording to the
late census, the class of '• Unfortunates " in the United
States gives a grand total of 98,434. Of blind, 20,320,
of whom 17,043 are native, and 3,277 foreign. Deaf

and dumb, 16,205; native, 14,089; foreign. 1,336.
Insane, 37,382; native, 20,101; foreign. 11,221. Idi-
otic, 24,527 ; native, 22,852; foreign, 1,075.

Baltimore College of Dental Surgery. — Since
this insiitniion was chartered in 1839, 082 students
have received its diploma. For many years the Balti-
more College was the only dental institution in the
world ; now, however, there are nine denUd colleges in
this country.

At the Thirty-.'jecond Annual Commencement, held
Februiiry 29, 1872, the degree of D.D.S. was conferred
upon eighteen graduates.

Death of an Old Physician. — Dr. IJicharu S. Spof-
ford, of Ncwburyport. died recently in that city, at the
age of 83 years and 8 months. He took his medical
degree at Harvard College in 1S15, and began practice
in Newburyport in 1810.

Commencements of Ohio Medical Colleges. — The
Miami Medical College held it5 regular annual exercises
February 29. Diplomas were presented to 07 gradu-
ates.

The Medical College of Ohio held its annual com-
mencement March 1st, and 87 of the graduating class
received diplomas.

Death of a Promise.nt Fkexcu Physician. — Dr.
Barthelemy Roch, President of the Medical As.sociation
of Alais, France, since the year 1854, died lately, aged
94 years.

An Enormous Aerolite. — A specimen weighing 36
tons has been pre.-ented to the Paris Academy of Sci-
ences by the Danish and Swedish Governments.

Secondary Haemorrhages. — In the " Surgical Let-
ters from the Field Hospitals of Weissenburg and Man-
heiin,"' by Dr. Tii. Billroth, of Vienna, translated for the
K'titsfts Citij Medical Journal, from the Berliner Klin.
Wuchenschrift, the subject of secondaiy hemorrhai.'es
is practically discussed. Amongst the 132 wounded
under his immediate charge at Weissenburg there were
10 cases of serious secondary hemorrhage — 11.7 per
cent, of all the cases. Of the sixteen, 13 died — 81.2
per cent. If those cases seen at Manheim are added,
there would be a total of 27, of whom 22 died — 81.4
per cent. In the lO cases noticed at Weissenburg, the
nature of the wounds was as follows: gunshot wound
of the neck, 2 ; gunshot wound of the chest, 2 ; gunshot
wound of the knee-joint, 1 ; gunshot wound of the foot,
1; gunshot fracture of the thigh, 6; gun.shot fracture
of the leg, 3 ; amputation o'' the thigh, 1. The hemor-
rhages occurred Irom the fourth to the 27th day after
the injury. In three instances — wonnds of the neck,
leg, and toot — compression and the tampon wore em-
ployed ; in two (wounds of the chest) deep sutures
were used ; all five of them died. In the remaining 11,
ligatures were applied as Ibllows : to the subclavian
artery, once (died) ; to the femoral artery, at the bor-
der of the sartorius, 5 times — 2 recovered, 3 died; to
the external iliac, 5 times — one recovered, 4 died. Of
these last 11 cases, only three succumbed as the direct,
result of the ligation ; the rest were carried ofl' by
pya?mia at a variable period after the application of the
ligature, and without anv hemorrhage having occurred
in the mean time.

Angiom.v Cavernosum. — An important case of angi-
oma cavernosum, situated in the external auditory
canal and attached by a slender ped.cle to the manu-
brium mallei, is the subject of a reprint from Knapp &
Moos' Arrh., II., 1. The paper is accompanied by a
well-defined steel cut illustration of the polypoid angi-
oma cavernosum.

THE MEDICAL RECORD.

121

(Drigiiral Commuu'icatious.

A CONTRIBUTION TO

THE KNOWLEDGE OF THE CHEMISTRY, AND

PHYSIOLOGICAL, THERAPEUTICAL, AND

TOXICAL ACTIONS OF

VERATRUM ALBUM, VERATRUM VIRIDE,

AND THEIR ALKALOIDS.

By EUGENE PEUGNET, M.D.,

(Read before the Medical Society of the County of New York.)

Mr. President and Gentlemen — A remarkable case
of poisoning by veratrum album having come under
my observation, I found, in searching its literature,
also studying its composition ami properties, its physi-
ological, therapeutical, and toxical effects, as well as
thoi^e of veiatrum viride, many facts of interest as to
their relative composition. The effects produced by
them and their alkaloids upon the animal economy,
although possibly not presenting anything absolutely
new or positively origuial, I have endeavored to con-
dense and digest into as small a compass as possible,
hoping that they might be of interest to the mem-
beisof this Society.

Botanical History. — Veratrum album and veratrum
viride belong to the same genus, their order being the
melantheca;; Linnean system, tlie polygamia monsecia.
Both are perennial plants, the first a native of Europe,
found principally in the Pyrenees and Switzerland,
the second a native of this continent, found principal-
ly between the Canadasnnd North Carolina. Although
botanists have failed to detect any essential differences
in their botanical relations, the plants differ essentially
in their composition and properties, as well as in their
therapeutical and toxical effects.

All portions of the plant of veratrum album are
poisonous, but the rhizoma or root is the only portion
used in medicine. It deteriorates by keeping ; whilst in
veratrum viride. Prof. Procter found the stem entirely
inert, the virtues of the plant residing in the rhizoma.

Chemical History. — Pelletier and Caventon analyzed
veratrum album in 1819, and found in it a salt, the
supergallate of veratria. which they considered identical
with the veratria obtained from the sabadilla seeds.

Simon believed that he had found two other alkaloids
in it, one of which he called jervina, after the Spanisli
poison of that name; the other baratyna, owing to its
being precii^itated from its solutions in acetic and
phosphoric acids by the addition of sulphuric acid or
the sulphates.

Fluckiger of Berne, in 1806, found another active
principle in it besides the veratria, but was unable to
isolate it sufficiently to ascertain its exact nature.

Not having been able to obtain either Simon's or
Fluckiger's processes for extracting the alkaloids, I
made use of the following one : —

A portion of either the imported powdered root, or
else some of the root which had been coarsely ground
here, was placed in ajar; a sufficient quantity of acetic
acid (spec. grav. 1036j diluted with twenty parts of
water, to cover the root, was added, and allowed to
stand for forty-eight hours; the whole mass Avas then
placed in a percolator, and allowed to percolate ; fresh
acidulated water added until the root was exhausted.

Having filtered the acidulated water through paper.

a precipitate was thrown down by the addition of a suffi-
cient quantity of carbonate of soda, a small quantity
of alcohol having been previously added to retain the
coloring matter. The carlionate of soda deepened the
color of the solution ; but any other alkali produces the
same effect. When the [irecipitate had fully separated,
the supernatant fluid was drained off, the precipitate
collected on a filter, tl!Oroui;hly waslied and dried. As
the addition of sulphuric acid or the sulphates had
only thrown down a prec'i)itate of lime from the solu-
tion in acetic acid, the precipitate was redissolved in
water acidulated with sulphuric acid; the only residue
left was a m nute portion of earthy salts and resinous
matter; nothing revealed the existence of baratyna.
A small quantity of alcohol having been added to the
solution, a precipitate was thrown down, by the addi-
tion of ammonia, sufficient to produce a slightly
alkaline reaction. The precipitat'^, collected on a tilter,
when thoroughly washed and dried was siiaken with
successive portions of pure ether (the purity of the
ether is essential, as I failed in several of my experi-
ments, owing to the presence of alcoh<j|), until two or
three drops of ether left no residue on evaporation ;
and a drop or two of sulpliuric acid on the evajjorating
dish or glass failed to pioduce any reaction.

The ethereal solution was then filtered and allowed
to evaporate ; the residue left was of a golden brown
color, and of a semi-crystalline appearance, due to the
presence of some resinous and coloring matter; it was
redissolved in water acidulated with sulphuric acid, the
solution filtered thus separating some undissolved resin-
ous matter; a small portion of alcohol added to tJie
filtrate to retain the coloring matter, then a precipitate
formed by the addition of ammonia; this was collected
on a filter, washed and dried ; it was then redissolved in
alcohol 95°, the solution digested with animal charcoal,
filtered, and a piecipitate formed by the addition of a
sufficient quantity of water, and collected on a filter ; at
first it was a[)parently colorless, but, as it dried, present-
ed a dull brownish-gray color, and was amorphous ;
redissolved in ether and filtered, it was left, on the
evaporation of the ether, in white scales on the dish.

The portion insoluble in ether was tieated with 95"
alcohol until exhausted, leaving a small residue^ con-
sisting of earthy salts and co'oring matter. The alco-
hohc solution having been filtered, a precipitate was
formed by the addition of a sufficient quantity ot water;
the precipitate collected on a filter; when dry it was
white, amorphous, and pulverulent.

A fluid extract having been prepared from the ex-
hausted root, the resin was precipitated by the addition
of a sufficient quantity of water, and collected on a
filter. When dry it was successively treated with por-
tions of water, respectively acidulated with acetic and
muriatic acids ; however, both failed to extract any-
thing further. As the resin was found to still possess
active properties (Exp. XXXVIII. to XLIV.), a portion
was treated with ether until exhausted, the ethereal solu-
tion filtered, and the ether allowed to evaporate; the
residue left was dark and oily, of the consistence of a
fieshly-prepared extract. A second portion was boiled
with successive portions of diluted ammonia until ex-
hausted, the residue collected on a filter, washed and
dried ; it was of a yellowish color, and pulverulent. A
third portion was boiled in successive portions of diluted
liquor potassa until a soft gelatinous mass remained,
solidifying and adhering to the bottom of the vessel
as the fluid cooled ; when dry it was of a brownish-
gray color, and pulverulent.

The resin w;;s precipitated from its solutions in liquor
potassa and ammonia by the addition of dilute sul-
phuric acid, washed and c'ried. I only succeeded in

li.'2

THE MKDK'AL KEroKD.

Rcporntinp by ammonin and pota>-sa the two principles
in ono 8|ircim<M of thv iiiiporicd pnwilfn"! root;
AvhiUl in thf imported root ground Inn-, I Tailed en-
tirely; once or twice th»Te wus a irmr in two pounds
of it. Tliis latt^-'r is pr.ibably due to the eiueless man-
ner in wliieh tiie root is patliered lor export; also to
the lenpth of time it may have been kept.

The first of the prinei[iles extracted by ether is un-
doubtedly the basis t«f ilu* salt obtained by Pelletier and
Caventon, s-ubsequen'iy by Simon ami others; it is
identical witli the vcrati oida of veratnmi viride. Sol-
uble in alcohol ami ehlorofoini, the alkalies and tlieir
carbonates i)rei'ipitate it from its solutions. Ii forms
.sjilLs with the acids; the sulpliate, nitrate, and niiiriale
are but sparingly soluble; the acetate readily "o; but
all of tliein reijuire an excess of acid to make them so.

When treated wi;h concentrated sulphuric acid it
dissolves to a reddish-yellow, ciianping to an ochrey-red,
then to a reddish-brown, thei. to a brown, in a few
hours lo a purp'e, which continues for some days. Dis-
solved ill nitric acid, it gives a rose-tinge. It does not
respond to the sulphuric acid, but does to Trappe's test
for veratria. It ha.s an acrid, pungent taste, a-.d a
powerful sternutatory etfect.

The second principle, the one extracted by alcohol,
is the jervina of Simon ; he found it to be compcsed
of Cso, Hjj, No, Oj. Will's analysi.s varies as lo the
number of t quivalents; at ISO' F. it loses four equiva-
lents of water, melts above that temperature, and fuses
at 300"^ F. ; is white, tasteless, and has no sternutatory
etfect. With acids it forms salts; the sulphate, muri-
ate, and nitrate are but sparingly soluble, wliilst
the acetate is more so. When treated with con-
centrated sulphuric acid, it dissolves to a yellow,
changing slowly to a grass-green, and in a few
hours becoming brown; in nitric acid to a red ro.-e,
then to a brick-fed, and finally to an orange-yellow,
which remains unchanged for some time; in muriatic
acid to a red rose; in boiling turns to a green.
The substance separated from the resin by ammo-
nia is soluble in alcohol, insoluble in ether, chlo-
roform, or acidulated water. AVhen treated with con-
centrated sulphuric acid, it produced a faint pink or rose-
color; with nitric acid, first a light rose, then turning
to a light brown ; with muriatic, a laint pink or rose.
It melts slowly and fuses. The subsfance, separated by
means of liquor potassa, is soluble in alcohol and chlo-
roform, and insoluble in ether, benzole, or acidulated
■water. When treated with comentrated sulphuric
acid it dissolves slowl}', producing first a dark-brown
color, ■wl'.ich finally turns to a reddish-brown; with
nitric acid, first a beautiful blood-red, then lo a light
brown; with muriaiic acid, no reaction whatsoever.
Melts eav<ily and fuses.

In this analysis we find that two alkaloils, the vera-
troida and jervina, have been extracted; and that the
resin ct>ntains a distinct organic principle, not of basic
origin, but existing in a complex form; it is therefore a
resinoiil, and is, properly speaking, the veratrine of vera-
trum album.

Mr. Freye, chemist for Messrs. Caswell, Hazard & Co.,
extracted the alkaloids lor me by the process made use of
by Mr. Charles Bullock in his aulysis of veratrum viride
(Amer. Journ. P/ia/TO., September, 1865, and Mai ch,
1866); that is, by the preparation ofatluidextract, giving
it a decided acid reaction by the addition of dilute acetic
acid, precipitating the resin by the addition of water,
collecting it on a filter; then precipitating the alkaloids
from the filtrate by the addition of carbonate of soda,
finally separating them by means of ether and alcohol.

Veratrum Viride. — In veratrum vir;de, Mr. H. W.
Wtrihington was the first to announce that he had

found an alkaloid which he considered identical with
veratriii. Mr. Joseph li. Uiclniid>on, in IS.'j?, stated
that he had found an alkaloid in it siindar to the one
extracted from veratrum album.

Mr. G. J. Se.iltergoo i, in lS(i"2, demonstrated that the
principle suppo-ed to be veratria, which he extracted
by means of water acidulated with sulphuric acid, was
associated with a resin jMissessing a greater sedative
ac:ion on the circulation than the resin itself.

Dr. S. II. Percy, in his prize essay, published in
1864, which is very exhaustive, con.sidered the alkaloid,
which he extracted by means of muriatic acid, identi-
cal with veratria. He al-o found that the resinoid
po.s.sesse<l au active sedative action.

In 1865, Mr. Chas. liuliock, of Philadelphia, made
an elaboiatc investigation of the composition of the
root, and found two distinct alkaloids in it, one soluble
in ether, the other insoluble, but both soluble in al-
cohol. Neitlier of these alkaloids responded in its
chemical reaitions to veratria; both were amorphous
and white, producing the same chemical reactions ;
viridia ditlVriug from veratroida in its in.solubihty in
ether and its higher fusing point, requiring from 335"
to 310' F., whilst that of the latter is from 270' to
275' F.

Mr. Bullock's process differed essentially from the
others, in that, instead of treating the root with acidu-
lated water, he first prepared a fluid extract, as men-
tioned heretofore.

Mr. G. J. Scattergood and Dr. Percy having demon-
strated by their iuvesligaiions that neither sulphuric nor
muriatic acids fully extracted the virtues of the root,
whilst Mr. Bullock demonstrated by his that acetic
acid does it etrectually, I extracted tlie alkaloids by the
same process made use of in extracting the alkaloids
from veratrum album.

The alkaloid veratroida, taken up by the ether, is
identical in its reactions and properties with the alka-
loid extracted in a similar manner from veratrum album,
and the name given to it in the last edition of the
United States Dispensatory is a very appropriate one ;
for although possessing some of the properties of the
veratria it is entirely distinct from it, as established by
the experiments of Richardson and Bullock, as well as
by the utter failure of either alkaloid to respond to
the sulphuric or to the nitric acid test when I tested
them; for veratria turns yellow with the latter.

The alkaloid viiidia, first obtained by Bullock by
means of its insolubility in ether and solubility in al-
cohol, is tasteless, white, amorphous, pulverulent, au'i
is not a sternutatory. The chemical reactions obtained
were absolutely the same as those of the jervina of
veratrum album ; neither of these alkaloids responded
to tests for veratria or the veratroida.

These reactions vary e>sentially from those obtained
by Bullock, but I think this is due to his having failed
to fully separate the veratroida from the viiidia, as the
purity of the ether is essential, to prevent a portion of
the viridia being taken up by it.

Then, in order to ascertain if the veratroida is fully
separated from the viridia, the evaporating and sulphuric
acid tests, as mentioned heretofore, should be tried.

There is an excess of the veratroida in veratrum al-
bum, and an excess of the viridia or jervina in veratrum
viride.

As to the exact proportions of the alkaloids to a
given quantity of the root, it is impossible to fully de-
termine. Mr. Bullock obtained from thirty-two ounces
of veratrum viride 9.2 grs. of veratroida, and 15.7 of
viridia; f om the same quantity of the root I obtained
about the same p; opoi tion ; from another a large excess
of viridia.

THE MEDICAL RECOHD.

123

The same is true of the so-called veratrin of Keith
& Co., and Tilden & Co., in some more of one and lr.s.s
of the other. From one specimen of Norwood's own
tinoture I obtained 1.5 gr. to the ounce of the com-
bined alkaloids, from another 1.9 gr. These variations
are almost entirely due to the manner in whicli tlic
root is gathered. The same is true of veratrum album.

I regret that tliis chemical history is not as thorou!i;h
and complete ^s it should be; but the want of a proper
laboratory, as well as a want of experience, must be
my excuse. I would here tender my thanks to Mr.
Ferd. Spangenberg for his valuable advice and assist-
ance in extracting and preparing the alkaloids.

The resin of veratrum viride was found to be en-
tirely inert.

Having shown that the two varieties of veratrum
possess much in common in their chemical history, but
that there exists in veratrum album a distinct principle
which does not exist in the other, I will pass to the
history of their physiological, therapeutical, and toxi-
cal effect-^.

Veratrum Album. — The first clear and succinct ac-
count of the history and effects of this variety was
published by Schabel, at Thulingen, in 1817, in his
inaugural thesis: he considered it a prompt and sure
emetic, and that in whatever manner administered it
produced nervous prostration and intestinal irritation.
Horn subsequently confirmed his views as to its ac-
tion as an emetic. In the various pharmacopoeias it is
now recommended as a sternutatory, when combined
with some innocuous powder.

It was formerly extensively employed in the treat-
ment of various nervous, gouty, and chronic cutaneous
hffections; but owing, to the uncertainty of its action,
and being powerfully irritant, it has gradually fallen
into disuse. However, in Germany its tincture enjoys
a great, and, I think, deserved reputation in the treat-
ment of pityriasis versicolor. It has a popular reputa-
tion on the continent and in England, in the treatment of
scabies and pediculi. By certain empiricists it is exten-
sively used in the treatment of certain forms of diarrhoea
and dysentery which have lost the'r acute character,
and have become subacute or chronic.

Pereira reports three cases of poisoning where an in-
fusion of the ro )t was taken, in which extreme prostra-
tion, without purging, resulted (Dr. Raynor's, of Stock-
port).

Christison, three cases, in which a quantity of the
powdered root was taken. In the course of an hour
they all experienced a burning sensation in the throat,
oesophagus, and stomach, followed by vertigo, purging
and dysuria, weakness and rigidity of the limbs, ver-
tigo, loss of sight, great faintness, convulsive breathing,
and small pulse. One of them, an elderly woman, who
had partaken of the largest quantity, had an impercep-
tible pulse, stertorous breathing, and total insensibility.
On the following day an eruption appeared on the
body.

He also quotes from Rust's journal, that a family of
eight ate bread in which some of the powdered root
had been mixed by mistake; in all of tlieni symptoms
of gastro-intestina! irritation manifested themselves.

Bias, two cases, one of Avhom, a boy three and a half
years of age, took from six to eight ounces of the de-
coction ; the other, an infant aged eighteen months, took
a smaller quantity ; botli recovered. They presented the
following symptoms : vomiting an acid fluid, containing
half-digested food, with yellow mucus; countenance
pale, head hot, general surface cold ; pulse small, slight
convulsive twitchings of the limbs; dilated pupils, eyes
staring, with revolving movements of the eyeballs.

Mavel d'Ambert (Jour, de Chimie, 1851) gives an ac-

count of the poisoning of an entire family, who had
partaken of soup made in a utensil in which a decoc-
tion of the root had been prepared the day before, and
which hail not been ihorou^ihly cleansed. They all
presented symptims similar to tiiose of cholera: the
mot'.ier, who suffered the mo-t, ho found in a state of
collapse, with a blue, anxious face, eyes expressionless
a:id loss of sight; pulseless; diminished temper.iture
of the body, and vomiiing incessantly, accompanied
with violent tenesmus. He first administered emetics;
when the vomiting had ceased, gave opium ; applierl dry
friction and mustaid sinapisms to various parts of the
body. In the couise of a few hours reaction set in.
On the fourth day a peculiar eruption broke out on one
of her calves, which could not have been produced by
the mustard.

Nivet and Giraud (Gaz. Ilebdom., vol. viii.. No. 31)
relate that three members of a family suffered frnm
poisoning by veratrum album, two of whom died. The
eldest brother, twenty-five years of age, was suddenly
taken ill, in the latter part of June or early in July,
18G0, with the following symptoms: violent pains in
the epigastrium, intense thirst, severe burning sensation
in the throat and upper portion of the abdomen; these
symptoms soon subsided. Some time afterwards, from
some unknown cause, they recurred with increased
violence.

On the 29th of August, Dr. Chalvignac observed
that his face was thin; expre-sion anxious; a
dark circle surrounding the eyes; sight only affected
whilst and immediately after vomiting; no delirium;
mind clear, temperature of the skin normal; inappe-
tency ; unqueni.hable thirst; burning sensation of the
epigastrium extending to the oesophagus ; acid ruetus;
frequent vomiting, increased by drinking, occasionally
sti eaked with blood ; sanguineous stools, accompanied
with tenesmus ; secretion of urine normal. He died
on the 31st of August.

The younger brother, twenty-two years of age, was
taken ill about the 1st of September, with symptoms
similar to those of his brother, with the exception of
sanguineous stools and tenesmus, and died on the 14tli
of September.

Their mother was taken ill on the 25th of August,
with symptoms similar to those of her sons. On the
29th the doctor observed the following symptoms : a
marked prostration, tinnitus aurium, sight only affected
whilst vomiting; insomnia; pulse seventy -five and
regular, tongue coated and smooth ; inappetency,
thirst not as intense as in the first days of her illness;
uniform redness of the mucous membrane of the throat,
sliuht tumefiictiou of the tonsils. The pain in the
throat, oesophagus, and epigastrium, at first intense,
has in a manner subsided; slight nausea; no purging
since the day before. If she attempted to rise or walk
there was a tremor in her limbs and uncertainty in her
gait. She continued to improve, but had a relapse, and
finally i ecovered on the 22d of September.

At the inquest, it was shown that — 1st. A white
powder had been administered to them. 2d. Some of
the root of veratrum albiun was found in a cooking
utensil. 3d. In the [lost-mortem, made October 15th,
that putrefaction was too far advanced to note patho-
logical changes. 4tl). The liver, intestines, pancreas,
lungs, and hearts of the brothers contained an alkaloid
similar to veratria. 5lh. Some of the substance ex-
tracted from the organs of the eldest brother, given to
a chicken, produced all the symptoms of poisoning by
veratria.

In the British Pharmaceutical Journal and Transact
fiouft for February, 1868, the case of a young man who
took a portion of three-penny-worth of the powdered.

124

THE MEDICAL RECORD.

root is reported. The cfTects of the poi«on immediately
manifesteil tiieiiis«-lves, and lie died in a comparatively
short time, in the prealest ag.ny.

Uifilii, in liis lrfuti.-e on i ox icolojiy, states that sev-
eral eases of uterine li« morrlmpe had been produced
l»y the u.se of the root a.s a sternutatory.

On the 4th of AugiK-t, 18 — , wliilsttm a f)rofessional
visit to a summiT lestirt, I was nque-tid to ete a
vounp mariii'd lady, who was in a ^taU- of collapse.

At about G.3(t r.M.. site h; d taken by mistake, as I
subsequently a.^certaimd, half an ounce of the lK)m(T"o-
pailiic mother tincture of vcratrum album, ((juivalent
to half a draclmi ot the powdered root ; liiis< tinc-
ture wji« prepared iu the llartz Mountains ol tiermany.
from the preen loot. In a subsequent analysis of the
same tincture, I found that each ounce contancd Ig
prain of the active piinciples of the root. She had
consequently taken | prain. Immediately after taking
it she felt soothed and quiet, having been exceedingly
nervous before.

At 10 p. M. her hands and feet became numb, a
sensation which gradually extt nded over ti.e whole
body. She attempted to rise, but had two attacks of
syncope in rapid succession ; was taken immediately
alterwards with violent vomiting.

10.3I.I p. M. — I Ibund her pulseless, heart pulsating
feebly ami irregularly; resp. iwenty-two and regular:
eyes fixed and staring; pupils dilated; a'most total
loss of sight; the body covered with a cold and clammy
perspiration; compleie anae-thesia of the skin; voice
as clear and as strong as in the collapse of cholera;
lips of a bright carmine; mind clear, calm, and col-
lected; thought that she was dying; vomiting and
retching inc< ssantly ; the fluid ejected was viscid,
glairy mucus, of a greenisii hue. As there was no
puroinp, and recognizing the action of some powerful
sedative poi^<)n, I jiave her an enema of brandy and wa-
ter, three ounces of each, and thirty drops of ammonia,
followed in a short time by a second, both of which
were retained; then rubbed her limbs with dry nms-
tard ; applied mustard plasters to the epigastrium ;
then administered a ihiid enema, which was forcibly
retained.

As violent purging accompanied with severe tenes-
mus set in shortly afterward-, recourse was had to the
administration of small quantities of brandy by the
mouth, at short intervals, and the application of ammo-
nia to the nostrils.

Aug. 5th. 1 A.M. — Pulse perceptible for the first time,
38, feeble and intermittent ; anaisthesia of the .--kin con-
tinues ; vomiting not as violent, purging ince>santly,
accompanied with tenesmus; can now see distinctly.
3a.m. — Pulse 44; anaestlie>ia continues; temperaiure
normal; intense thirst. 10 a.m. — PuL-^eSG; vomiting
occasionally ; salivated and bloody stools frequent;
marked pain in left iliac re^don, extending to left hyf)0-
chondrium, increased by pressure.

Aug. Gth, 6 a.m. — Pulse 100; parsed a restless night;
tympanitis, marked tenderness of left, iliac region ;
nausea, vomiting at intervals ; tenesmus, with bloody
stools every hour; pupils normal ; anaesthesia persistent;
thirst intense.

A ug. 8th, 6.30 a.m.— Pulse 105 ; tongue dry, furred,
and brown; gums inflamed and tender, bleedi'i;g freely
at intervals; aphthous idceration of the p:date ; breath
ofifensive ; ptyalism [ rofuse ; nau-ea per.Mstent; vomit-
ing occa<;ionally ; stools frequent and bloody ; occa-
sional exarcerbaiion of pain in lefi iliac re-iun and left
hypochondrium, increased by pressure.

Aug. lOth. — Pul-e 105; tongue furred ; gums ulcer-
ated ; nausea, but no vomiting ; purging not as frequent ;
stjols no longer bloody; ansesthe^ia of the lower ex-

tremities ; a profuse flow of blood from the uterus
came on duritip the night, alihou<^h ilic menecs were
not due until the 'J2d.

Aug. l\/h. — PuNe 94 ; marked improvement. Prom
this lime forward she continued to pain rapidly. The
treatment, after reaction took y)lare, consisttd ol opium,
bi«nnith, and camphor, to check diarrhoea and allay
pain ; < flervescinp draughts to allay nausea; the diet of
milk and lime-water, al.so brandy and be^f-tea.

Aug. 14//(. — 1 left her, as I Rnppo.sed, convalescing;
she felt comparatively well, diarrhoea almost checked,
otcat-ional anaestlies a of the upper ai.d lower extremi-
ties. On the lOih sat out of doors ; on the 17th took a
ride ; on the 18th another ; was tjiken that, night with
violent tenesmus and catiiarsis; stools bloody; also
slij^ht nausea.

Aug. 22(1, 12.15 A.M. — Having been telegraphed for,
I found Iter pulse lU2 ; ton.L-ue furred and brown, edges
red, papilhc raised; tympaniti.«, tenesmu.«, pain in left
iliac re;;ion, e^fiendmgtolcft hypochondrium, increased
by pressure ; frequent bloudy stools ajid nau.sea.

Aug. 2bt/i. — Left her improving, with directions for
her removal to the ci:y on Monday, the 28th, as I
did not deem it prudent for her to remain longer,
owing to tlie marked insalubrity of the place, caused by
miasm and defective drainage ; as there then were in
tiie same wing of the hotel two cases of dysentery, one
of which was typho malarial. The treatment, as sug-
gested by a veiy intelligent practitioner before 1 was
sent tor. was the occasional administration of Squibbs
liquor opii comp.

Attg. 2'Jth. — Arrived home last night; passed an un-
comfortable night; pnlse 100; recurrence of dianhoea;
evacuations very offensive, black, also some mucus,
streaked with blood ; nausea, vomited twice, viscid
greenish mucns, streaked with blood; tongue fui red.
Ordered enema ot liquor ferii persulphatis, 20 drops in
= iv. of water every four hours, which weie discontinu-
ed after the third, on account of the pain and violent
hysteria ; .5 drops of the liquor were administered every
four hours instead, also a pill containing argenti nitras
-^i gr. and ext. opii ^^ gr. every alternate 4 hours.

tSrpt. 2d. — Sanguineous stools having ceased, peps'ne
gr. iij. and bismuth trisnitras gr. xv. were given every
two hours; quinije sulphatis gr. ij. every fourth hour;
paregoric whenever nccossiry to allay tenesmus.

iiej't. Sth. — Prof. Alonzo Clark in consultat'on. Pulse
84; tongue smooth and clear; pain in left il.ac region,
exiending upward? ; from fourteen to sixteen stools in
the twenty-four hours, dark and small, accompanied
with tenesmus. Morphise sulphas tV gr. added to
pepsine and bismuth.

Sept. \7th. — Pulse 102 ; tongue furred, dry and brown,
edges red, papillae raised ; no improvement, as the mor-
phine was evidently actingas a nervous irritant ; di-scon-
tinued i', atid substituted salicine gr. v. every foiir
hours, discontinuing all other remedies.

S''pt. 22c/. — Marked improvement ; lying on lounge.

Sept. 2oth. — Evacua'ions very frequent, containing
mucus streaked with blood ; in.-isted npon piving au
enema of Oj. of warm water, with long flexible tube,
which siie had heretofore sirennoush' objected to. Con-
siderable mucus, streaked with blood, came away, also
shreds of mucous membrane, and but a trace of Isecal
matter; the pain from the distention of the intestine
was intense; ordered a suppositoiy of ext. opii aq. and
argenti nitras iUl gr. i every lour hours.

Sepi.2Gth. — Feels more comfortable ; fewer evacua-
tions; administered an enema of warm water Ojss. ; it
was followed by a dischaige of mucns streaked with
blood, shreds of mucous membrane, and but little faecal
matter.

THE MEDICAL RECORD.

125

Sept. 27lh. — Improvement continues; another enema
a-lminis^tcred, followed by a discharge of less mucus,
but few shreds of mucous membrane, and partially
formed fajces, but quite attenuated.

Sej^t. 30th. — Steadily plaining; a fourth enema admin-
istered, followed by llie fust well-formed and perfecily
healthy evacuation, with the exception of its extreme
attenuation, evidently caused by a contraction of the
colon.

From this time forward the recovery was rap'd; with
t'le exce[)tion of insomnia, n'TVOusnes-;, tremor of the
limbs, uncertainty of gait when the first attempts to
walk were made, the only nervous symptoms wliirii
manifested themselves during the progress of the ea<e
were the loss of sight, paralysis of the recti muscles ofthe
eye, and the ansesthesia ; this last symptom persisteil un-
til the middle of September, migratory in its character,
recurring principally on the anterior surface of the
forearm, and on the thigh following the course of the
anterior c: ural nerves. The urine was not examined at
first, but in subsequent examinations an abundancf of
amorphous matter with a large amount of the crystals
of oxalate of lime were found.

The only remedy which effectually controlled the
insomnia was the hydrate of ch'oral in ten-grain dos.^s.

I regret that the temperature was not taken note of;
but as I did not expect to require my thermometer, I
had left it at home.

The digestion was so much impaired, that milk,
grurl-, beef-tea, broths, steaks, and confections ef raw
beef had to be successively abandoned ; game, chicken,
fish, and bread being exclusively relied upon. i

The emac ation, at first very great, rapidly disapp'^ar- |
ed. On the 31st of January following her health was
perfect, and the tbecal evacuations had entirely recover-
ed their natural form and size.

There are several points of interest in this case. !

I. That the poison had been taken fully three hours [
before any decided symptoms manifested themselves,
and therefore absorbed. • j

II. That the poison taken into the circ ilation acted \
directly on the vaso-motor nerve<, is seen by the anaes- |
thesia, the loss of s ght and paralysis of the recti mus- i
cles, and diminution ofthe temperature.

III. Tliat its powerful sedative action on the circu- ;
lation only manifested itself after its primary action on 1
the nervous system.

IV. That its action on the alimentary canal as an
emetic and cathaitic was due to its special acion on
the pneumogastric nerve, through the circulation, and
not to any action as a local irritant, is shown by the
fact that these were the last symptoms develojied in- i
stead of the first — a'so by the experiments of Prof. \
Horatio Wood wiih th'i veratroida.

V. That the first pathological change in the alimen-
tary catial, from the gums to the rectum, was probably
one of the intense hyperaemia and congestion, due to \
a paralysis of the vaso-motor nerves, and that a thick-
ening and contraction ofthe intestines ensued; and
that the gastro-enteritis was a secondary effect, will
be shown by Exp. XXXIII. to XLVIL, inclusive. \

VI. That the contrai-tion of the colon, causng the
extrem'^ attenuation ofthe faeces, was not due to ulcera-
tion and cicatrization, is shown by its gradual and
perfect restoration; further, that there was not at any ;
time any indication of intestinal obstruction. |

VII. That the uterine hemorrhage was the result
of an intense uterine congestion will bs shown by Exp.
XXXVIII. ,

In experimenting upon anima's, Schabel observed
that three grains of the powdered root, applied to the
nostrils of a cat, killed it in sixteen hours ; thak a ,

small piece of the root, inserted into the rectum of a
cat, was followed in fifteen minutes by dyspnoea, frothy
vomiting, alvine evacuations; root expelleil ; finally,
inflammation of the rectum with a tendency to prolap-
sus. Three grains of the extract, introduced into the
trachea of a cat, caused gastro-enteritis and death;
poison absorbed by left lung.

Orfila introduced into the thigh of a dog fifteen
grains of the powdered root ; it caused vertigo, vomit-
ing, and purging, then in seven hours <leath The
post-mortem revealed slight inflatumation ofthe mucous
membrane of the stomach, and red patches of this
membrane in the rectum.

Viborg and Scheele injected from twenty-five to
thirty drops of the tincture into the jugular veins of
several horses and cows ; vomiting, purging, and tenes-
mus were the effects produced ; but in half an hour
they had all subsided.

Schroff, of Vienna, says, " that neither veratria nor
veratrum produces gastro-enteritis, but that at the site
of their operation they produce a pa-sing hype: ajmia, re-
sulting, if intense, in the shedding ofthe epithelium of
the stomach and intestines. Nau~ea is a constant re-
sult of the vomiting; but the purgative action ot
the drug is uncertain. Spinal spasms affecting animal
life are wanting; symptoms of reflex paralysis present
themselves.

" There is a great tendency to increase the secretion
of the intestinal canal; it accelerates the evacuation of
the fteces; but when given in poisonous doses
it does not produce diarrhoea. Golden coincides with
Schroff."

Dr. Oulmont, of Paris, in various experiments on
dogs, rabbits, and frogs with the tincture of veratrum
album — administered hypodermically — gives the fol-
lowing as the result of hi-j observations: —

" The fiist effect was on the circulation ; a remarkable
falling ofthe pulsa'ions, then a diminution of tlie tem-
perature of fiom one to five decrees; the respiration
becoming slow and irregular; followed by vomiting
and purging. The most prominent symptom was the
extreme prostration, followed by insensibility and total
loss of power; the animal totally insens ble to e'ectric
shocks or anv other irritation; finally, inflammation of
the entire alimenrary canal, followed by death in
from one to three hours."

In briefly reviewing the various cases of po'soning
quoted, as well as the experiments and conclusions of
various observers, I find that whenever the root has
been given, either in sub.stance or its tincture, and in
whatever manner administered, the same symptoms
have invariably manifested themselves in a greater or
less degree, according to the quantity taken, and
which are so concisely and teiscly described by Oul-
mont. However, I doubt whether gastro-enteritis had
had time to develop itself in his experiments, and I
pre'er to indorse the views of Schroff and Golden a.s
to its being intense hyperaemia. In reference to its
modus operandi, I expressed my views in reviewing
my case of poisoning, and will enlarge upon it when
treating of

Veratrum Viride. — You are so familiar wit'i veratrum
viride, that it is almost a work of superfluity to enter
into a detailed history of its virtues ; however, I will be
as brief as possible.

Although Doctors Tully and Ives were the first to
investigate its therapeutical virtues, the attention of
the profession was not called to it until the publication
of a very able paper by Dr. Charles Osgood, of Provi-
dence, R. I., in 1835 {Am. Jour. Med. Sckncei^, vol. xvi.,
296); but it was only brought into general use after
the publication of the pamphlet of Doctor W. C.

126

THE MEDICAL RECORD.

Norwood, of Cokesb'irj', S. C, jii 1H.')1 ( f'h'irlvMton
J/rt/. lirr., vol. vii., 768). lie ha<l a n-iiinrkable suc-
c«'pswitli it in the ireatiiicnt orpneiiinDiiia and tvplioid
fever; l>y otliers it w;i8 rocommemled in tiu! treatment
of intlaniniatory rlieuniati.^in. puerperal fever, and otlier
iiiflainiiiaiory dise;ises; by Professdr G. B. Wood, in
nduciiif: the pulse in cardiac diseases. Dr. Jarqui-mier
first alluded t<» it in France, in a review of Prof.
Fordyce Barker's essay on its use in puerperal fever
(Gaz. //<•/.</., 18')7).

In 18GG, I)r. Theodore Ko<:licr publislied an e.>;>ay at
Wurizbinp on the tnatment of pneumonia by the
jireparatitins of veiatnim viride; it wa.>* based upon
ti.e treatment of si.vty casos of iincomplicat<-d pmumo-
nia by the exclusive u.se of tiie resin of v. rairum
viride, at tlic C'linique of Berne, by Profe-sorBiermer ;
the mortality was only eipht, 3 per cent, le-s than
followe 1 any other course of treatment. 21 cases out
of 2"), in which the first manifestation of the disease
could be exactly established, recovered in less than six
dav.^.

Dr. Oulmont, in an e>say read before the Acadimy
of Medicine. Paris (Hul. Gen. de Therap., Ixxiv., 145),
in 18G7, warmly advocates its use in inflammatory
afTections.

It is generally aflmini'stered in tincture, or fluid ex-
tract; b}' some the resin is preferred. Dr. S. R.
Percy advises the use of a tincture prepared from the
resin which has been exhausted by water acidulated
with sulphuric acid, but th's does not fully extract tlie
veratroida, and if it did, the tincture would not pos-
sess any sedative action. The most reliable prepara-
tion is Norwood's, but even that cannot ahva^'s be
relied upon, as the root does not always contain the
same proportion of the alkaloid-s.

This, like many of our most valuable remedies, is
falling into disuse on account of the uncertainty of its
action, also owing to the unf>lea.sant nans -a. vomiting,
an! even purging it sometimes occasions; but fortu-
nately cheniisiry and physiology, as proven by the ex-
periments of ScatUTgood, Percy, BuUock, ami Horatio
Wood in our own country, and those of Fluckiuer and
Oulmont in Europe, have revealed '.he existence of
alkaloids to which all i:s therapeutical virtues are due.
We will therefore not be obliged to see it sooner or later
set a«ide, like its more active sister plant, and used
only as a local application in the treatment of pityria-
sis versicolor, scabies, and pediculi, for which it is
ju«t as efficacious.

Uncertain as it is in its effects, I have found but one
recorded f ital case resulting from its u-e, that of a feeble
child, aged one year and six nonihs. to whom its
mother had ndiiiinis'ered, without the advice of a phy-
sician, probabl}' not less than o5 drops of the tincture,
in four or five divided doses, at intervals of half an
hour. There was an attempt to vomit afier the second
dose ; altliough the efforts were made every few
minutes, there was only one successful, when a small
quantity passed by the mouth. Dr. J. C. Harris, of
West Cambridge, saw him seven hours after he had
taken tlie fi:st dose; he found him very pale, appar-
ently unconscious, breathing almo-t ste:toous; pulse
40, extremities cold, and a profuse cold perspiration
over the whole body. He died thirteen hour